BOARD OF GOVERNORS MEETING #246
June 4, 2015 ● 2:00 PM L.A. Care Health Plan 1055 W. 7th Street, Los Angeles, CA 90017
1 About L.A. Care Health Plan
Mission Statement L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
Overview Committed to the promotion of accessible, affordable and high quality health care, L.A. Care Health Plan (Local Initiative Health Authority of Los Angeles County) is an independent local public agency created by the State of California to provide health coverage to low-income Los Angeles County residents. With more than 1.6 million members in five product lines, L.A. Care is the nation’s largest publicly operated health plan.
L.A. Care Health Plan is governed by 13 board members representing specific stakeholder groups, including consumer members, physicians, federally qualified health centers, children’s health care providers, local hospitals and the Los Angeles County Department of Health Services.
L.A. Care advances individual and community health through a variety of targeted activities including a Community Health Investment Fund that has awarded more than $132 million throughout the years to support the health care safety net and expand health coverage. The patient-centered health plan has a robust system of consumer advisory groups, including eleven Regional Community Advisory Committees (governed by an Executive Community Advisory Committee), health promoters, and three Family Resource Centers that offer free health education and exercise classes to the community, and has made significant investments in Health Information Technology for the benefit of the more than 10,000 doctors and other health care professionals who serve L.A. Care members.
Programs Medi-Cal – In addition to offering a direct Medi-Cal line of business, L.A. Care works with three subcontracted health plans to provide coverage to Medi-Cal members. These partners are Anthem Blue Cross, Care 1st Health Plan, and Kaiser Permanente. Since 2012, L.A. Care has enrolled more than 170,000 Seniors and Persons with Disabilities as members, and as of January 1, an additional 164,000 Healthy Way LA members transitioned to L.A. Care’s Medi-Cal program. Medi-Cal beneficiaries represent a vast majority of L.A. Care members.
L.A. Care Covered™ – As a state selected Qualified Health Plan, L.A. Care provides the opportunity for all members of a family to receive health coverage under one heath plan in the Covered California state exchange.
L.A. Care Cal MediConnect Plan– L.A. Care Cal MediConnect Plan provides coordinated care for Los Angeles County seniors and people with disabilities who are eligible for Medicare and Medi-Cal.
L.A. Care Healthy Kids (0-5) – Sponsored by First 5 LA and the Children’s Health Initiative of Greater Los Angeles, Healthy Kids (0-5) provides health coverage for children who do not qualify for Medi-Cal and Healthy Families.
PASC-SEIU Homecare Workers Health Care Plan – L.A. Care provides health coverage to Los Angeles County’s In-Home Supportive Services (IHSS) workers, who enable our most vulnerable community members to remain safely in their homes by providing services such as meal preparation and personal care services.
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Updated 5/29/2015 AGENDA BOARD OF GOVERNORS MEETING No. 246 Thursday, June 4, 2015, 2:00 P.M. L.A. Care Health Plan, 10th Floor, 1055 W. 7th Street, Los Angeles, CA 90017
Teleconference Call In Information & Michael A. Rembis Teleconference Site 19265 Allandale Drive Call in number: (855) 846-1604 or (213) 438-5445 Tarzana, California Participant Access code: 67163639 I. Welcome Thomas Horowitz, D.O., Chair II. Approve today’s meeting agenda Chair III. Public Comment Chair IV. Approve May 7, 2015 meeting minutes Chair V. Approve Consent Agenda Items Chair 1. Approve rescheduled July 2015 Board meeting (BOG 100) 2. Approve New Leases with Canon (FIN 100) 3. Approve Contract with Center for the Study of Services (FIN 101) 4. Approved Contract Extension with McKesson, and Approval to enter negotiations with Health Dialog (FIN 102) 5. Approve Contract with Craig Stephen/Beecher Carlson Holdings, Inc. (FIN 103 ) 6. Approve Contract Amendment with Ansafone (FIN 104 ) 7. Approve Contract Amendment with Office Ally (FIN 105 ) 8. Approve Contract with Vendor Not Yet Selected for Health Benefits Exchange Quality Improvement Phase I (FIN 106) 9. Approve Contract with Cognizant, Flextech, HCL and Infosys for Professional Services (FIN 107) 10. Approve Procurement of Licenses with TriZetto (FIN 108) 11. Approved Revised Annual Compliance Program Work Plan (COM 100) 12. Approve RCAC Membership (ECA 100) 13. Ratify RCAC 3 Vice Chair Election (ECA 101) VI. ADJOURN TO CLOSED SESSION (Est. time: mins.) Chair A. CONTRACT RATES Pursuant to Welfare and Institutions Code Section 14087.38(m) Plan Partner Rates Provider Rates DHCS Rates B. REPORT INVOLVING TRADE SECRET Pursuant to Welfare and Institutions Code Section 14087.38(n) Discussion Concerning New Product Lines Estimated date of public disclosure: May 2017 C. CONFERENCE WITH LEGAL COUNSEL – ANTICIPATED LITIGATION Pursuant to Section 54956.9 (d)(2) of the Ralph M. Brown Act Two (2) potential cases
3 5/29/2015 10:07 AM Board of Governors Meeting Agenda June 4, 2015 D. CONFERENCE WITH REAL PROPERTY NEGOTIATORS Pursuant to Section 54956.8 of the Ralph M. Brown Act Property: 1055 West 7th Street, Los Angeles Agency Negotiator: John Baackes Negotiating Parties: Jamison Properties, 1055 West Seventh, LLC Under Negotiation: Price and Terms of Payment VII. RECONVENE IN OPEN SESSION Chair VIII. Chairperson’s Report Chair IX. Chief Executive Officer Report John Baackes Chief Executive Officer X. Chief Medical Officer Report Gertrude S. Carter, MD Chief Medical Officer XI. Motions for Consideration Gertrude S. Carter, MD 1. Health Integrated (BOG 101) 2. Approve Procurement Policy (AFS-007) and the elimination of the Tim Reilly Contract Review and Approval Process Policy (AFS-026) (BOG 102) Chief Financial Officer XII. Advisory Committee Reports A. Executive Community Advisory Committee Hilda Perez/Ozzie Lopez Board Consumer member and Advocate member XIII. Committee Reports A. Executive Committee Thomas Horowitz, D.O., Chair 1. Government Affairs Update Cherie Fields Director, Government Affairs 2. Approve Ad hoc award to the Nonprofit Finance Fund Jonathan Freedman (EXE 100) Interim Chief Operating Officer/ Chief of Strategy, Regulatory and External Affairs B. Finance & Budget Committee Michael Rembis, Chair 1. Financial Report (FIN 109) Tim Reilly 2. Monthly Investment Transactions Report Tim Reilly C. Compliance & Quality Committee Meeting G. Michael Roybal, MD Chair D. Services Agreement Committee Hector De La Torre Chair XIV. Strategic Discussion: Value Proposition of L.A. Care John Baackes
XV. Adjournment Chair The next meeting is scheduled on Thursday, July 2, 2015.
The order of items appearing on the agenda may change during the meeting. Teleconference arrangements may change prior to the meeting. Those planning to participate by telephone should confirm with L.A. Care Board Services prior to the meeting. Please keep your comments to three minutes or less.
5/29/2015 10:07 AM 4 Board of Governors Meeting Agenda June 4, 2015
THE PUBLIC MAY ADDRESS THE BOARD OF GOVERNORS ON ALL MATTERS LISTED ON THE AGENDA BY FILLING OUT A “REQUEST TO ADDRESS” FORM AND SUBMITTING THE FORM TO L.A. CARE STAFF PRESENT AT THE MEETING BEFORE THE AGENDA ITEM IS ANNOUNCED. YOUR NAME WILL BE CALLED WHEN THE ITEM YOU ARE ADDRESSING IS DISCUSSED. THE PUBLIC MAY ALSO ADDRESS THE BOARD ON L.A. CARE MATTERS DURING PUBLIC COMMENT. AN AUDIO RECORDING OF THE MEETING IS MADE TO ASSIST IN WRITING THE MINUTES AND IS RETAINED ONLY FOR 30 DAYS. NOTE: THE BOARD OF GOVERNORS CURRENTLY MEETS ON THE FIRST THURSDAY OF MOST MONTHS AT 2:00 P.M. POSTED AGENDA and PRINTED MEETING MATERIALS ARE AVAILABLE FOR INSPECTION AT Board Services, 1055 W. 7th Street – 10th Floor, Los Angeles, California 90017.
Any documents distributed to a majority of the Board Members regarding any agenda item for an open session after the agenda has been posted will be available for public inspection at Board Services, L.A. Care Health Plan, 1055 W. 7th Street, 10th Floor, Los Angeles, CA 90017, during regular business hours, 8:00 a.m. to 5:00 p.m., Monday – Friday. Meetings are accessible to people with disabilities. Individuals who may require any accommodations (alternative formats – i.e., large print, audio, translation of meeting materials, interpretation, etc.) to participate in this meeting and wish to request an alternative format for the agenda, meeting notice, and meeting packet may contact L.A. Care’s Board Services Department at (213) 694-1250. Notification at least one week before the meeting will enable us to make reasonable arrangements to ensure accessibility to the meetings and to the related materials.
5/29/2015 10:07 AM 5 Board of Governors General Meeting # 245 Meeting Minutes – May 7, 2015 L.A. Care Health Plan Conference Room 1018-1019 1055 W. Seventh Street, Los Angeles, CA 90017 Members Management/Staff Thomas Horowitz, DO, Chairperson Alexander K. Li, MD John Baackes, Chief Executive Officer Mark Gamble, Vice Chairperson Ozzie Lopez, MPA Gertrude S. Carter, Chief Medical Officer Michael A. Rembis, FACHE, Treasurer Hilda Perez Jonathan Freedman, Interim Chief Operating Officer and Louise McCarthy, Secretary G. Michael Roybal, MD, MPH Chief of Strategy, Regulatory & External Affairs Michael D. Antonovich Sheryl Spiller Augustavia J. Haydel, Esq., General Counsel Hector De La Torre Kimberly Uyeda, MD, MPH Tim Reilly, Chief Financial Officer Jann Hamilton Lee Tom Schwaninger, Chief Information Officer *Absent ** Teleconference Robert Turner, Chief of Human Resources AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN CALL TO ORDER Thomas Horowitz, DO, Chairperson, called the meeting to order at 2:05 p.m. Thomas Horowitz, DO, Chair Horowitz announced that the Public may address the Board on any matter at the Public Comment section at the beginning of this meeting, or by submitting a form available at the entrance. He also announced that there will be a Services Agreement Committee meeting immediately following this meeting.
APPROVAL OF The meeting agendas were approved as submitted. Approved unanimously. MEETING AGENDA 10 AYES (Gamble, Hamilton Lee, Horowitz, Thomas Horowitz, DO Lopez, Li, McCarthy, Perez, Rembis, Roybal, and Uyeda).
PUBLIC COMMENT There was no Public Comment. ACCEPTANCE OF (Member Spiller joined the meeting.) Approved unanimously. MINUTES OF The minutes of the April 2, 2015 Supplemental Special and Regular meetings were approved as 11 AYES (Gamble, MEETING submitted. Hamilton Lee, Horowitz, Lopez, Li, McCarthy, Thomas Horowitz, DO Perez, Rembis, Roybal, Spiller and Uyeda). DRAFT 6 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN APPROVAL OF 1. Revised 2015 Board and Committee meeting schedule (EXE 100) Approved unanimously. CONSENT AGENDA 2. Quarterly Investment Report (FIN 100) 11 AYES 3. Maricich Healthcare Communications Contract Amendment (FIN 101) Thomas Horowitz, DO 4. Procurement of Additional Managed Service Hours from Black Box Network Services (FIN 102 ) 5. Key Vendor Contract to Enhance Disk Storage Space (FIN 103) 6. Healthx Contract (FIN 104) 7. Wanski Contract Renewal (FIN 105) 8. Inovalon Contract Amendment (FIN 106) 9. Approve Gomez Research Contract (FIN 107) 10. Approve RCAC Membership (ECA 100) 11. Ratify election of RCAC 4 Vice Chair (ECA 101)
ADJOURN TO Augustavia Haydel, Esq., General Counsel, announced the following items to be discussed in closed session. The Board CLOSED SESSION adjourned to a closed session at 2:10 p.m. Thomas Horowitz, DO (Member Antonovich joined the meeting.) A. CONTRACT RATES Pursuant to Welfare and Institutions Code Section 14087.38(m) Plan Partner Rates Provider Rates DHCS Rates (Member De La Torre joined the meeting.) B. REPORT INVOLVING TRADE SECRET Pursuant to Welfare and Institutions Code Section 14087.38(n) Discussion Concerning New Product Lines Estimated date of public disclosure: May 2017
RECONVENE IN The Board reconvened in open session at 2:40 p.m. OPEN SESSION Thomas Horowitz, DO
CHAIRPERSON’S Chair Horowitz reminded Board Members that the election of Board Officers was deferred until REPORT after the transition in L.A. Care leadership.
Board of Governors Supplemental Special Meeting May 7, 2015
DRAFT 7 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN Thomas Horowitz, DO Staff is polling for a Governance Committee meeting in June, 2015. A solicitation letter for officer nominations will be sent out as soon as that meeting date is determined. Nominations will be accepted until voting begins; it is anticipated that the election will occur at the July 2, 2015 Board meeting.
CHIEF EXECUTIVE John Baackes, Chief Executive Officer, reported OFFICER REPORT John Wallace has resigned effective April 30, 2015, as L.A. Care’s Chief Operating Officer (COO). Mr. Baackes noted that Mr. Wallace was a terrific asset to the organization judging John Baackes from the reaction from staff of his departure. He complemented and thanked Mr. Wallace for his role as the Interim Chief Executive Officer and for the briefing he provided during the transition. Mr. Wallace provided operational leadership during a time of extraordinary growth for the organization. Mr. Wallace oversaw the roll out of several health care reform programs such as the launch of L.A. Care Covered, transition of Seniors and People with Disabilities and Dual Eligibles into managed care, and the expansion of Medi-Cal. Jonathan Freedman, Chief of Strategy, Regulatory and External Affairs, has been appointed as interim COO. Search for the COO will begin after the ongoing L.A. Care strategic vision process. Bruce Pollack, Senior Director of Project Management Office, has also been appointed as Core System Conversion “Czar”. On April 30, 2015, Mr. Baackes attended the Regional Community Advisory Committees Conference (RCAC) at the Our Lady of Angels Cathedral, his first in-depth participation with RCAC activities. He was impressed with the organization of the conference and the consumer members’ participation. He congratulated Member Perez and stated his continued support for RCAC activities. Member Perez thanked Carrie Broadus, former RCAC and Board Member, for her participation. 3-5 Year Strategic Vision Planning In Progress L.A. Care’s Leadership Group is refreshing L.A. Care’s 3-5 year strategic vision with the intent to update its existing strategic priorities at the start of the fiscal year on October 1, 2015. Organizational Jonathan Freedman, Interim Chief Operating Officer and Chief of Strategy, Regulatory & External Affairs, Performance Report presented the 2nd Quarter Organizational Performance Report FY 2014-2015 included with the Board of Governors Supplemental Special Meeting May 7, 2015
DRAFT 8 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN materials for this meeting (a copy of his report can be obtained by contacting Board Services). Jonathan Freedman Mr. Freedman reported: The organizational performance report summarizes the status of organizational goals and objectives outlined in the Board approved fiscal year 2014-15 budget. Most goals are on target but some goals are partially met. These goals will be met later in the year based on strategic planning that the Board will undergo in future months. Improvement in Medi-Cal dis-enrollment caused by re-determination shifts between Covered California and Medi-Cal due mainly between CALHEERS and County eligibility process. In response to Member McCarthy’s question if L.A. Care is tracking involuntary dis- enrollments, Mr. Freedman informed Board Members that involuntary dis-enrollments are based on re-determination and termination of eligibility for government sponsored programs. L.A. Care receives monthly statistics of dis-enrollments. Increase to L.A. Care’s Mr. Baackes announced that in line with recent discussions by the L.A. City Council and SEIU, Minimum Wage L.A. Care decided to increase its minimum hourly wage to $15. Other changes will be made to L.A. Care’s compensation structure over time to ensure L.A. Care is on the frontline of the living wage movement. L.A. Care plans to also offer health benefits to new hires sooner. Mr. Baackes added that these actions acknowledge L.A. Care’s greatest asset – its employees, and to help to fulfill its mission and values. Timing of June and July The Executive Committee approved the change in the date of L.A. Care’s annual Board retreat Board meetings from May to September 2015. Mr. Baackes noted that staff felt it would be better to move the retreat to allow him the opportunity to understand the organizations’ existing vision, challenges, and opportunities. Mr. Baackes added that he would like the Board to participate in this process and proposed dedicating one hour at the June and July 2015 Board meetings for strategic discussions that will direct the development of an updated strategic vision. One of the main topics for discussion is the value L.A. Care adds to members and providers, from the perspective of different constituencies.
STANDING COMMITTEE REPORTS EXECUTIVE Chairperson Horowitz reported that the Committee met on April 30. (Minutes of the meeting can be COMMITTEE obtained by contacting Board Services.) Board of Governors Supplemental Special Meeting May 7, 2015
DRAFT 9 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN Thomas Horowitz, DO Motion approved on Motion EXE 100.0515* Consent Agenda To approve the revised Board of Governors meeting schedule resetting the date for the Approved unanimously Board of Governors’ Retreat from May 7, 2015 to September 3, 2015, and for the under Consent Agenda. Compliance & Quality meeting from May 21, 2015 to May 26, 2015 as attached. 11 AYES Government Affairs Mr. Freedman informed Board Members that Cherie Fields is in Sacramento attending a meeting Update regarding amendments to SB 147. Mr. Freedman introduced Prity Thanki, Local Government Advisor, Government Affairs, who reported: Prity Thanki State Budget The Governor’s State Budget May Revise is anticipated to be released next week. Recent reports indicate that California’s income tax collections in April have already exceeded the Brown Administration’s January estimates. The Legislature’s nonpartisan fiscal analyst is reporting that, by June 30, state revenue could exceed estimates by more than $4 billion dollars. The State budget outlook will become clearer after Governor Brown releases his revised budget plan next week. It is anticipated that most extra revenue will go to K-12 schools and community colleges due to Proposition 98. The budget revision will also show the Administration’s latest approach on the rainy-day reserve and debt repayment plan approved by voters last November. It will be difficult for Governor Brown to agree to provide additional funding for Medi-Cal and other health and human service programs or to restore prior cuts. It is highly unlikely that significant increases or restorations of funding will be included in the budget revise. Legislative Update A legislative matrix was provided with today’s meeting materials. SB 147 (Hernandez) Related to Federally Qualified Health Centers (FQHCs) co-sponsored by L.A. Care, California Primary Care Association (CPCA), and the California Association of Public Hospitals and Health Systems (CAPH). This would create a 3-year pilot program for an alternative payment methodology for specific FQHCs. This bill is currently in Senate Appropriations Committee.
Board of Governors Supplemental Special Meeting May 7, 2015
DRAFT 10 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN The Department of Health Care Services (DHCS) has agreed to provide data that should allow the bill to move off of the suspense file in the next couple of weeks. Bill sponsors continue to work with health plans and clinics on language and expectations of the pilot program. SB 33 (Hernandez) SB 33 limits estate recovery in the Medi-Cal program by requiring collection for only those health care services required to be collected under federal law. This bill is scheduled to be heard in Senate Appropriations. Because there is a cost associated with the bill, it is anticipated it will be put on suspense and will be dealt with at a later time. SB 4 (Health Care for All) (Lara) On April 7, 2015, legislators announced a package of ten bills called, “Immigrants Shape California”. The package aims to protect undocumented immigrants from fraud, discrimination, lack of health care, and the unintended consequences of the United States’ criminal justice system. This bill would provide Medi-Cal benefits to low income undocumented individuals and require the State to ask for a federal waiver to include the undocumented in Covered California health plans. It is estimated that SB 4 could cost the state anywhere between $175 million to $740 million annually. Exactly how much depends on whether the President’s Executive Order becomes effective, giving about 5 million undocumented immigrants protection against deportation. The order was issued late last year but it remains blocked for now in federal court. SB 4 was placed on suspense in Senate Appropriations Committee. It is highly unlikely this bill will get off of suspense because of the potential costs. Even if it passes out of the suspense file and wins a vote on the Senate floor, it would still face votes in the Assembly and ultimately would need Governor Brown’s signature to become law. AB 858 (Wood) AB 858 allows FQHCs to provide and be reimbursed for medical and mental health services to Medi-Cal beneficiaries on the same day and in the same location. Currently an outdated provision of the law prohibits same day billing for medical and mental health services, even though it does allow same day billing for medical and dental services. If the bill is passed out of Appropriations and by the Legislature, it is unknown if the
Board of Governors Supplemental Special Meeting May 7, 2015
DRAFT 11 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN Governor would approve the bill due to its increased cost. Medi-Cal 2020 Waiver Renewal Proposal to Centers for Medicare and Medicaid Services (CMS) On March 27, 2015, DHCS submitted a final draft to CMS for a 1115 Medicaid Waiver that requests $17 billion and permission to start new programs that will change payments and health care benefits for the Medi-Cal program. If CMS approves the application, California would become the first state to use financial incentives to increase preventive care visits for Medi-Cal beneficiaries and the uninsured as a way to cut emergency care costs. It also would make California the first state to include housing assistance and other social services in its plans to improve care and outcomes for homeless people. This new Waiver replaces the current Waiver that expires at the end of October 2015. It would continue some programs in the expiring waiver that helped California in implementing the Affordable Care Act and the launch of Covered California. CMS is reviewing the State’s application. DHCS expects the new Waiver to be in place by November 1, 2015. FINANCE & BUDGET Michael Rembis, Treasurer, reported that the Committee met on April 30. (Minutes of the meeting COMMITTEE can be obtained by contacting Board Services.) In addition to the motions approved earlier on today’s consent agenda, the Committee approved the following motions that do not require Board Michael Rembis approval: Contract amendment for $12,000 with Laura Gonzalez to provide nutrition workshops for the Active Steps Program from March 2, 2015 through February 29, 2016. Contract with North Star Alliance for $275,000 to provide a series of community outreach events in Los Angeles County to promote L.A. Care’s direct lines of business for the period of June 1, 2015 through May 31, 2016. Contract with Telemundo 52 for $250,000 to provide advertising and marketing services from June 1, 2015 through June 1, 2016. Motions approved on Motion FIN 100.0515* Consent Agenda To accept the Investment Report for the quarter ended March 31, 2015, as submitted. Motion FIN 101.0515* To authorize staff to amend a contract with Maricich Healthcare Communications in the amount of $4,710,000 (total contract amount not to exceed $9,310,000) to support the advertising, marketing, translation services and development of an integrated brand Board of Governors Supplemental Special Meeting May 7, 2015
DRAFT 12 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN strategy and positioning for L.A. Care’s direct lines of business from September 1, 2015 through August 31, 2016. Motion FIN 102.0515* To authorize staff to procure additional Managed Service Hours with Black Box Network Services to support L.A. Care’s Interactive Voice Response (IVR) and Motions FIN 100.0515 Voicemail System upgrade in an amount of $40,000 (total contract amount not to exceed through 107.0515 were $504,000) through May 31, 2016. approved unanimously Motion FIN 103.0515* under the Consent To authorize staff to execute a contract with a vendor not yet selected to procure Agenda. 11 AYES equipment and installation services for the purpose of expanding disk storage infrastructure in the amount of $650,000. Motion FIN 104.0515* To execute a contract with Healthx for L.A. Care’s Member and Provider Portal Strategic implementation services, for an amount of $2,500,000, through March 31, 2017. Motion FIN 105.0515* To authorize staff to execute a contract with Joseph Wanski, MD from August 1, 2015 through July 31, 2016, for a total amount not to exceed $242,500. Motion FIN 106.0515* To approve an amendment with Inovalon, Inc. to increase funds in the amount of $90,000; bringing the total three year contract cost from $1,183,920 to $1,273,920 for the period of August 1, 2014 to August 31, 2017. Motion FIN 107.0515* To authorize staff to execute a contract in the amount of $250,000 with Gomez Research to provide market research services from June 1, 2015 to May 31, 2017. Financial Report Tim Reilly, Chief Financial Officer, reviewed highlights of the financial report for the period ended March 31, 2015. (Copy of the report can be obtained by contacting Board Services.) Tim Reilly Total overall enrollment for March is 1,689,099 members. Fiscal year-to-date performance is a surplus of $64.3 million or 2% on revenue. Total enrollment for the Plan Partner (PP) Network is 800,000 members. Fiscal year-to-date performance for PP Network is a surplus of $27million. Total enrollment for L.A. Care’s direct Medi-Cal line of business (MCLA) is 775,000. Board of Governors Supplemental Special Meeting May 7, 2015
DRAFT 13 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN MCLA’s fiscal year-to-date performance is a surplus of $64 million, mainly driven by higher than expected Medi-Cal Expansion membership growth and lower than budgeted operating expenses. Approved unanimously. Total enrollment for the Cal MediConnect (CMC) program is 10,000. Fiscal year-to-date 13 AYES (Antonotich, De performance is a deficit of $16 million driven by lower than budgeted revenue rates and La Torre, Gamble, higher than budgeted operating expenses. Hamilton Lee, Horowitz, Lopez, Li, McCarthy, Motion FIN 108.0515 Perez, Rembis, Roybal, To accept the Financial Report for the six months ended March 31, 2015, as submitted. Spiller and Uyeda). Monthly Investment Mr. Reilly referenced the Investment Transaction Report included in the meeting materials (a Transaction Report copy of the report can be obtained by contacting Board Services). Tim Reilly Mr. Reilly informed the Committee that as of March 31, 2015, the market value of L.A. Care’s investments was $1,717 million. This includes $50 million invested with the Los Angeles County Pooled Investment Fund (LACPIF) and $10 million with the Local Agency Investment Fund (LAIF). Both of these are recent placements with these government pooled funds which are overseen by the County Treasurer (LACPIF) and State Treasurer’s office (LAIF) respectively. The remaining $1,658 million is managed by Payden & Rygel, an external professional asset management firm, and is divided into two separate portfolios based on investment style: short-term and extended portfolios. Mr. Reilly noted that this is an informational report, and Committee or Board action is not required. Response to L.A. County Mr. Baackes noted that as previously reported, L.A. Care was audited by the L.A. County Auditor Auditor-Controller in January 2015. L.A. Care was in agreement with the recommendations Approve Expense and made by the Auditor-Controller as a result of that audit, and updated its expense policies in Travel Expense response. Mr. Baackes added that he spoke to John Naimo, the LA County Auditor-Controller, Policies to better understand the future direction and scope of the audit. On May 13, 2015, L.A. Care will meet with the Auditor Controller, and will discuss future John Baackes audits. The final report will be presented to the L.A. County Board of Supervisors on May 29, Tim Reilly 2015. Mr. Reilly summarized the changes to the policies. Expense Policy changes: Defines non-travel related and travel related expenses, and expenses that are necessary, reasonable, appropriate and allowable.
Board of Governors Supplemental Special Meeting May 7, 2015
DRAFT 14 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN Outlines procedures for pre-approval of all non-travel related business expenses. Outlines procedures for using the most recent federal guidelines for meal dollar limits per person. Sets a $5,000 per project expense limit that requires approvals from the responsible Officer, CFO, CEO, and/or Board of Governors. Provides procedures for monitoring and reporting which include quarterly reports to the Board of Governors. Eliminates purchase of alcoholic beverages; meals or entertainment expenses with vendors or firms seeking to do business with L.A. Care; routine working lunches; and meals or entertainment for birthdays, retirement, or similar related activities. Travel Expense Policy changes: Provides updated procedures on pre-approving all L.A. Care business related travel expenses via travel authorization requests. Provides updated procedures on preparing expense reports and documentation requirements for reimbursement for L.A. Care business travel. Updates guidelines on travel expenses that are covered and not covered under this policy. Provides procedures for monitoring and reporting which include quarterly reports to the Board of Governors. Prohibits the purchase or reimbursement of alcoholic beverages with L.A. Care funds. Member Antonovich thanked Mr. Reilly for the superb job with the revised policies. Member Antonovich added one issue that needs to be looked into is measuring the administrative cost. Comparing L.A. Care’s administrative cost and expenses with other Local Approved unanimously. Initiatives is like comparing apples and oranges because L.A. Care’s delegated responsibilities to 13 AYES Plan Partner or IPAs are not reflected. Member Antonovich proposed that this issue be discussed with the Auditors. Mr. Baackes noted that L.A. Care reached out to Mr. Naimo to provide additional background relevant to evaluating health plans and to discuss the audit structure and to develop an audit plan. The policies were approved by the Finance Committee and are presented to the Board for consideration. Motion FIN 109.0515 Board of Governors Supplemental Special Meeting May 7, 2015
DRAFT 15 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN 1) To approve the Expense and Travel Expense Policies, as attached, and to authorize staff to make non-significant changes, and, 2) To direct staff to report on the policies to the Finance and Budget Committee and the Board in 6 months from their adoption and for the Committee and the Board to reevaluate the policies in one year from their adoption. Second Quarter Mr. Freedman referred the Board to his written report included in the meeting materials (a copy Prequalified Vendor of his report can be obtained by contacting Board Services). Report Jonathan Freedman SERVICES Hector De La Torre, Committee Chair, reported that the Committee met on April 2 (Minutes of AGREEMENT the meeting can be obtained by contacting Board Services). COMMITTEE Mr. De La Torre was elected the Chair of the Committee. The Committee met in closed session to discuss Plan Partner Services Agreements and Hector De La Torre Trade Secrets. There was no report from that closed session.
PUBLIC ADVISORY COMMITTEE REPORTS EXECUTIVE Hilda Perez/Ozzie Lopez, Member and Member Advocate Representative to the Board, COMMUNITY reported that ECAC met on April 8 (Minutes of the meeting can be obtained by contacting Board Services). ADVISORY Earlier on the Consent Agenda, the Board approved motions for RCAC and CCI Council COMMITTEE (ECAC) membership, and to ratify election of RCAC 4 Vice Chair. Hilda Perez/Ozzie Lopez L.A. Care Health Promoters continue training and working with RCAC and community members, providing workshops on health improvement topics and access to care. The Coordinated Care Initiative Council staff reported that they visited various senior centers, and participated in several events throughout the four CCI Council areas in an effort to increase CCI Council membership. CCI Council field staff is collaborating with the Member Outreach Retention and Engagement (MORE) team to help identify potential CCI Council members in the four areas. ECAC members acknowledged process improvements by the Interdisciplinary Team and the results for the member issues submitted. Board Member Pérez requested that a presentation from the Interdisciplinary team be scheduled at a future Board Compliance & Quality Committee meeting. The RCAC spring conference was held on April 30, 2015 in downtown Los Angeles. The
Board of Governors Supplemental Special Meeting May 7, 2015
DRAFT 16 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN Agenda included internal and external guest speakers such as Susie Baldwin, MD, MPH, Chief, Health Assessment Unit, Office of Health Assessment and Epidemiology, Los Angeles County Department of Public Health, who reported on key indicators of health throughout L.A. County. RCAC members had an opportunity to discuss key indicators of health, how they affect individual RCAC regions, and what RCAC members can do to help advocate for their communities within L.A. Care and other organizations. There was also a behavioral health panel discussion that provided information on behavioral health benefits and how to access them. Motion ECA 100.0515* To approve the following candidate(s) to the Regional Community Advisory Committees (RCAC), and Coordinated Care Initiative Councils (CCI) as reviewed by the Executive Community Advisory Committee (ECAC) during the April 8, 2015 ECAC meeting. Name RCAC # Type of Member (Agency, if applicable) Andria McFerson RCAC 6 Consumer Higinio Carrillo RCAC 8 Consumer Elizabeth Lyons CCI Council Area 2 Consumer Hillary Marides CCI Council Area 2 Consumer Mary Jo Fernando CCI Council Area 2 Consumer Deaka McClain CCI Council Area 4 Consumer
Motion ECA 101.0515* To approve the election of Elizabeth Bonilla as Vice Chairperson of the Regional Community Advisory Committee (RCAC) of region 4 to complete the remainder of the term until September 2016 as reviewed by the Executive Community Advisory Committee during the April 8, 2015 meeting.
ADJOURNMENT The meeting was adjourned at 3:35 p.m.
Respectfully submitted by: APPROVED BY: ______Malou Balones, Committee Liaison Louise McCarthy, Secretary Hilda Stuart, Committee Liaison Date Signed ______Board of Governors Supplemental Special Meeting May 7, 2015
DRAFT 17
Board of Governors MOTION SUMMARY
Date: March 5, 2015 Motion No. BOG 100.0615
Committee: Chairperson: Thomas S. Horowitz, D.O.
Issue: Revised 2015 schedule of meetings for the Board of Governors and Committees
Background: The Board approved a schedule of meetings for 2015 at the September 2014 meeting. The meeting schedule for July 2015 Board meeting is revised due of scheduling conflict of some of the Board Members.
Budget Impact: None.
Motion: To approve the revised schedule of the July 2015 Board meeting, as attached.
18 Board of Governors MOTION SUMMARY
Revised 2015 Board and Committee Meeting schedule Regular meeting schedule according to the dates and times below: BoG: Board of Governors, meets at 2:00 for approximately 3 hours, and BoG meets at 12:00 Noon in March, July, October and December for strategic discussion C&Q: Compliance and Quality Committee, meets at 2:30 p.m. for approximately 2 hours Exec: Executive Committee meets at 2:30 p.m. for approximately 2 hours F&B: Finance & Budget Committee meets at 1:00 p.m. for approximately 90 minutes CHCAC: Children’s Health Consultant Advisory Committee meets at 8:30 a.m. for approximately 2 hours ECAC: Executive Community Advisory Committee meets at 10:00 a.m. for approximately 2 hours TAC: Technical Advisory Committee meets at 9:00 a.m. for approximately 2 hours
All meetings are held at 1055 West 7th Street, 10th Floor, Los Angeles, CA 90017
January 2015 February 2015 March 2015 April 2015 No BoG meeting 2/5 – BoG 3/5 – BoG 4/2 – BoG 1/14 - ECAC 2/11 - ECAC (strategic focus 12-2 pm) 4/8 - ECAC 1/15 – C&Q 2/25 –F&B, Exec 3/11 - ECAC 4/30 – F&B, Exec 1/20 - CHCAC 3/17 - CHCAC 1/28 –F&B, Exec 3/19 - C&Q 1/29 - TAC 3/24 – F&B, Exec 3/26 - TAC
May 2015 June 2015 July 2015 August 2015 5/7 – BoG (All day Retreat) 6/4 – BOG 7/8 - ECAC No meetings 5/13 - ECAC 6/10 - ECAC 7/22 – F&B, Exec 5/19 – CHCAC 6/24 – F&B, Exec 7/16 – C&Q 5/21 – C&Q 7/21 - CHCAC 5/27 – F&B, Exec 7/23 – TAC 5/28 – TAC 7/30 – BoG
September 2015 October 2015 November 2015 December 2015 9/3 – BoG 10/1– BoG (strategic focus 11/5– BoG 12/3 – BoG (strategic focus 9/9 - ECAC 12-2 pm) 11/11 - ECAC 12-2 pm) 9/15 - CHCAC 10/7 - ECAC 11/17 - CHCAC LACH & JPA (if needed to 9/17 - C&Q 10/28 F&B, Exec 11/18 – F&B, Exec confirm officers) 9/23 - F&B, Exec 11/19 - TAC 12/9 - ECAC 9/24 - TAC 11/19– C&Q
19
Board of Governors MOTION SUMMARY
Date: June 4, 2015 Motion No. FIN 100.0615
Committee: Finance & Budget Chairperson: Michael Rembis
Issue: Execute new leases with Canon, Inc. to replace 13 copiers.
Background: Staff requests approval to replace 13 existing copiers and leases with Canon, Inc., of various lease dates, for an additional cost of $63,970 per year.
L.A. Care made the decision several years ago to use multi-function Canon machines (copy, scanning & fax capabilities) instead of stand-alone desktop devices. This was a strategic business decision primarily to protect PHI as well as reduce the number and variety of stand-alone devices agency wide. There are typically two multi-function Canon machines that support approximately 120 employees per floor. The machines operate embedded software applications including eCopy and Secure Print. Due to L.A. Care’s growth and the fact that all printing, scanning and fax jobs are directed to these Canon machines, their use and print volumes have increased dramatically. The three Canon machines in the Copy Center made approximately 6 million copies in the last fiscal year alone.
Staff has identified 13 aging, high-volume Canon multi-function units for replacement. The service call reports for these units indicate increased down time. Because L.A. Care employees use these machines extensively it is critical for work productivity that they are reliable.
Canon is considered a Sole Source vendor because of eCopy, Secure Print and several other embedded software applications. The plan is to replace up to 13 machines and to redeploy lower copy volume machines to strategic areas to get the most effective and efficient use from their remaining useful life.
The breakdown of cost is: Leases Monthly Cost Annual Cost
13 Current Leases $71,168 $854,013
13 Replacement Copier $76,499 $917,983 Leases Increase $5,331 $63,970
Budget Impact: Sufficient funds are included in the Facilities budget for FY 2014-15, and they will be included in the FY 2015-16 Budget.
Motion: To authorize staff to replace existing copiers and leases with Canon, Inc., with various lease dates, for an additional total of $63,970 per year.
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Board of Governors MOTION SUMMARY
Date: June 4, 2015 Motion No. FIN 101.0615
Committee: Finance & Budget Chairperson: Michael Rembis
Issue: Execute a contract with the Center for the Study of Services (CSS) for a survey of Medi-Cal member satisfaction with participating provider groups.
Background: For the past several years, L.A. Care has scored in the 25th percentile on major Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures. It is critical to capture patient experience at the provider group level in order to identify opportunities for improvement in this survey, and to design interventions to improve the quality of services and raise Medi-Cal member satisfaction. To this end we will be fielding the Clinician and Group CAHPS (CG-CAHPS) as part of the LA Pay-for-Performance Program (LA P4P).
LA P4P measures, reports, and provides financial rewards for provider group performance across multiple domains and measures. In 2014, L.A. Care established baseline measures with its first fielding of the CG-CAHPS for participating provider groups. The 2015 CG-CAHPS survey results will be used to measure improvement in patient experience at the provider group level, and will be the basis for incentive payments for performance and improvements in member satisfaction for providers that participate in LA P4P.
Staff requests authorization to contract with Center for the Study of Services (CSS) for an amount not to exceed $728,336, from June 1, 2015 through May 31, 2016. CSS is to conduct the 2015 member satisfaction survey with services provided by select provider groups as part of LA P4P incentive program.
A competitive bid process was conducted for the 2015 survey in which seven firms were invited to bid. Four firms replied in sufficient detail for evaluation and CSS was selected. CSS is an NCQA-certified survey firm.
The budget for this survey is based on a bid by CSS to conduct the CG-CAHPS for rating patient experience with L.A. Care’s network of provider groups in 2015 as part of LA P4P.
Staff anticipates that at least 40 medical groups will have enough L.A. Care members with office visits in the past 12 months to qualify for the survey. L.A. P4P seeks to benefit as many members as possible by surveying and reporting performance on as many provider groups as can be assessed in a statistically valid manner.
Budget Impact: The $728,336 cost of the contract is budgeted in the QI Department for FY 2014-15 and will be requested for FY 2015-16. Motion: To authorize staff to execute a contract with Center for the Study of Services (CSS) for an amount not to exceed $728,336, to conduct the 2015 member satisfaction survey with services provided by select provider groups, for June 1, 2015 through May 31, 2016.
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Board of Governors MOTION SUMMARY
Date: June 4, 2015 Motion No. FIN 102.0615
Committee: Finance & Budget Chairperson: Michael Rembis
Issue: Extend a one-year contract with McKesson, and enter into negotiations with Health Dialog for a three-year contract for Nurse Advice Line Services.
Background: L.A. Care provides its members access to a Nurse Advice Line (NAL) 24-hours per day, 7 days per week (24/7) as required by Department of Managed Health Care. L.A. Care requires subcontracted health plans to provide NAL services for their members as well. Since 2003 L.A. Care has contracted with McKesson to provide a NAL for the direct lines of business membership. Members call the NAL and speak with a registered nurse and are triaged to the appropriate level of care. Based on 2013 through 2014 data, an average of 17% of NAL callers claimed a pre-intent to seek emergency care. After speaking to the NAL, 86% of these callers followed the nurse’s recommendation to a lower level of care (i.e., self-care). The current contract with McKesson expires June 30, 2015.
Staff requests to extend the Nurse Advice Line Services contract with McKesson for the period July 1, 2015 to June 30, 2016, in an amount not to exceed $1,180,892, in order to provide an orderly transition to the new vendor during a time of significant change within L.A. Care. Also, staff requests authorization to enter into negotiations with Health Dialog for Nurse Advice Line Services for a three- year contract in an amount not to exceed $2,207,167, beginning no later than July 1, 2016 and to execute the contract upon conclusion of negotiations.
L.A. Care issued a Request for Proposal (RFP) in October 2014 for NAL services. Responses were received from four bidders, including McKesson. A selection team evaluated the proposals using the criteria stated in the RFP. Health Dialog was selected based on its superior technical proposal and favorable pricing. In particular, Health Dialog demonstrated greater flexibility in how L.A. Care’s diverse membership can contact the NAL.
L.A. Care will require time to transition to the new vendor. This transition is complicated by the need to meet new NCQA member communication standards, the conversion to ICD-10 and ongoing challenges with the implementation of the core system. Therefore, prior to entering into negotiations with Health Dialog, L.A. Care intends to extend the McKesson contract for one year to provide an orderly transition to the new vendor during a time of significant change within L.A. Care.
The existing NAL contract with McKesson is for $1,660,307, and expires June 30, 2015. Staff seeks approval of a one year extension to the McKesson NAL contract, from July 1, 2015 to June 30, 2016, in the amount of $1,180,892. In addition, Staff seeks approval to enter into negotiation of a three-year contract with Health Dialog, to begin no later than July 1, 2016 in an amount not to exceed $2,207,167.
22 Board of Governors MOTION SUMMARY
Budget Impact: Sufficient funds are budgeted in Medical Administration Expense for the current fiscal year and funds will be requested for FY 2015-16.
Motion: To authorize staff to: 1. Extend the Nurse Advice Line Services contract with McKesson for the period July 1, 2015 to June 30, 2016, in an amount not to exceed $1,180,892 in order to provide an orderly transition to the new vendor during a time of significant change within L.A. Care.
2. Enter into negotiations with Health Dialog for Nurse Advice Line services for a three-year contract in an amount not to exceed $2,207,167, beginning no later than July 1, 2016 and to execute the contract upon conclusion of negotiations.
Page 2 of 2 23
Board of Governors MOTION SUMMARY
Date: June 4, 2015 Motion No. FIN 103.0615
Committee: Finance & Budget Chairperson: Michael Rembis
Issue: Contract with Beecher Carlson Holdings, Inc., for pharmacy consulting services in support of L.A. Care’s Pharmacy Benefit Manager (PBM) vendor.
Background: Staff requests approval to execute a contract with Beecher Carlson Holdings, Inc., from July 1, 2015 through December 30, 2015, in the amount of $225,000, with two possible six month extensions through June 30, 2016 and December 31, 2016, respectively, for an additional $450,000. Staff will evaluate prior to end of each contract term and extend only if services continue to be necessary. The contract total will not exceed $675,000. Beecher will provide L.A. Care with pharmacy management expertise and consulting services in support of L.A. Care’s PBM vendor.
Beecher Carlson will provide leadership, mentorship and technical expertise to re-engineer the roles, assignments and accountabilities within the pharmacy department. Beecher will work closely staff to establish the vision and work plan to effectively interface with external vendors supporting the success of L.A. Care’s pharmacy function. He will also lead new initiatives related to pharmacy management.
Beecher Carlson will assign Craig Stephens as the consultant. For the past six years, Mr. Stephens has assisted in identifying and implementing strategies for performance improvements of L.A. Care’s PBM. He provided leadership and expertise during the request for proposals process to select a new PBM vendor for 2015, which included the evaluation of five PBM bidders, including Navitus, the PBM that we chose and currently use.
With his expertise and prior experience with L.A. Care, including his knowledge of our market, plan partner relationships and provider group arrangements, Mr. Stephens is uniquely qualified to provide these services to L.A. Care, so we are not conducting a request for proposals for this contract, and we propose that he be classified as a Sole Source Vendor.
Beecher will bill L.A. Care a fee of $225 per hour. Craig Stephens is located in Minneapolis, Minnesota, and he will travel to Los Angeles on a weekly basis, where he will provide 30 hours of consulting services while at L.A. Care’s offices. L.A. Care will compensate him for all reasonable related travel expenses, not to exceed $105,000 for 18 months.
Budget Impact: Sufficient funds are budgeted in the Pharmacy department in FY14-15 and will be requested in FY15-16.
Motion: To authorize staff to execute a contract with Craig Stephens/Beecher Carlson Holdings, Inc. to provide pharmacy management expertise and consulting services, for a total amount not to exceed $675,000, from July 1, 2015 to December 30, 2016.
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Board of Governors MOTION SUMMARY
Date: June 4, 2015 Motion No. FIN 104.0615
Committee: Finance & Budget Chairperson: Michael Rembis
Issue: Execute a contract amendment with Ansafone for continued call center vendor services. Background: Staff requests approval to execute a contract amendment with Ansafone (headquartered in Santa Ana, California) adding $9.7 million through December 31, 2017 (total contract not to exceed $14.7 million). As stated in the September 2014 Finance and Budget motion (FIN 109.1014), Member Services will evaluate costs annually for each contract year.
In late 2013, L.A. Care staff released a call center vendor request for proposal (RFP) and solicited bids from leading national call center vendors with state and federal programs experience. Four vendors responded, including Ansafone, the incumbent vendor. Based on RFP submissions, Ansafone’s pricing was competitive versus other national call center vendors and the lowest in some categories. Based on value propositions, experience, implementation timeframes and resource requirements, Ansafone and CareCall were the two vendors selected.
The current executed contract for this vendor is for a 3-year term (2014-2017). The amendment request for additional funds applies to existing terms, which sets high accountability performance standards for the vendor. The current pricing schedule will not change and there are no planned pricing amendments at this time. However, staff will continue to monitor and evaluate the cost for each contract year and negotiate terms via amendment process, should there be a need.
Although the L.A. Care Member Services call center is the primary member and provider call center, L.A. Care outsources overflow, after hours, and outbound call functions to Ansafone. In 2013, significant growth in membership resulted in increased member and provider line volume. Due to internal resource and capacity constraints, Member Services shifted the provider line to Ansafone in January 2014. Since then, provider line volume has steadily increased. The inbound provider line comprises an average of 90% of Ansafone’s L.A. Care volume. The majority of the requested funding is to continue to manage provider call volume.
With a new space plan to be implemented in summer 2015, Member Services will begin recruiting, training and onboarding additional full time staff, with the goal of reducing call volume sent to vendors.
Budget Impact: The budget for call center services is sufficient for FY2014-15 and these costs will be budgeted in Member Services FY2015-16 budget.
Motion: To authorize staff to execute a contract with Ansafone for an amount not to exceed $9.7 million through December 31, 2017, for call center services.
25
Board of Governors MOTION SUMMARY
Date: June 4, 2015 Motion No. FIN 105.0615
Committee: Finance & Budget Chairperson: Michael Rembis
Issue: Amend the contract with Office Ally to provide hosted 270/271 and 276/277 claim status and eligibility/benefit transactions.
Background: L.A. Care staff requests approval to amend the contract with Office Ally in the amount of $31,560 through December 31, 2015 (total amount not to exceed $1,059,704) to provide hosted claims and eligibility/benefit transactions.
A competitive bid was conducted in May 2014 selecting Emdeon as the vendor of choice as it offered the lowest real time transaction cost to handle such vendor-hosted real-time services. However, extensive delays are preventing the execution of the Emdeon contract, which is not anticipated to be complete until the end of 2015.
The request to expand the scope of work with Office Ally will assist L.A. Care to be compliant with Health Insurance Portability and Accountability Act (HIPAA) Transactions, Code Sets, and Identifiers (TCI) standards; as L.A. Care is required to have a hosted 270/271 and 276/277 claim status and eligibility/benefit transaction processes in place.
The cost associated with this transaction is based on a onetime initial set up fee of $4,500 each, a total of $9,000, and a monthly fee of $1,000 for the first 1200 transactions with a $0.10 per transaction fee after the first 1200 claims.
Budget Impact: Sufficient funds are budged in the Claims Department budget for FY2014-15. Additional funds will be budgeted for in FY 2015-16.
Motion: To authorize staff to amend a contract in the amount of $31,560 with Office Ally (total amount not to exceed $1,059,704) to provide hosted claims status and eligibility/benefit transactions, through December 31, 2015.
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Board of Governors MOTION SUMMARY Date: June 4, 2015 Motion No. FIN 106.0615
Committee: Finance & Budget Chairperson: Michael Rembis
Issue: Execute a contract with a key vendor not yet selected to commence the Health Benefit Exchange (HBEX) Quality Improvement Phase I project to stabilize and enhance the L.A. Care Covered product line.
Background: Staff requests authorization to execute a contract for up to $750,000 through September 30, 2015, for the HBEX Quality Improvement Phase I project. L.A. Care launched a new product line, L.A. Care Covered, on December 1, 2013. In the first enrollment year the data from CalHEERS (Covered California) was problematic and it was decided to load that data into QNXT with the intention of fixing the data afterwards via programmatic scripts. While many of these scripts were successful, some caused further damage. In the second year of enrollment, we expected the data to have improved. After open enrollment was completed the same challenges arose.
We have now changed strategy to build out more complex logic in the QNXT enrollment engine to detect erroneous data and reject it back to CalHEERS, which is the source of records. It is imperative to begin work now to be ready for the upcoming open enrollment season.
The vendor selected will deliver the following scope of work: 1. Building and maintaining the project plan and deliverables 2. Business impact analysis of applications and systems 3. System integration and testing 4. Implementation of the deliverables 5. Manage defects, issues and system changes
The vendor selected will help perform data corrections and provide system improvements through scripts by comparing production member eligibility information against other sources of data. The vendor will additionally conduct continuous data reviews to identify other data discrepancies such as duplication of member case ID’s, case ID’s terminated or voided for currently active enrollment, all which will support our ongoing efforts to be compliant in preparation for the upcoming open enrollment season.
L.A. Care will conduct a competitive process and the vendors to be considered are: Cognizant, HCL and Infosys, all vendors with which L.A. Care has previously contracted and who have health plan experience and the proven ability to support and maintain L.A. Care’s specific needs. Their knowledge and expertise allows for an easy immersion into the project and consequently be efficient while allowing for time and cost savings over an extended period of time.
Budget Impact: This project was not budgeted, however, there are sufficient savings within the Information Technology project budget in FY14-15 to accommodate this request. Motion: To authorize staff to execute a contract with a vendor not yet selected, in an amount not to exceed $750,000 for phase 1 of the HBEX Quality Improvement Project for Fiscal Year 2015 through September 30, 2015.
27
Board of Governors MOTION SUMMARY Date: June 4, 2015 Motion No. FIN 107.0615
Committee: Finance & Budget Chairperson: Michael Rembis
Issue: Execute contracts with the following existing vendors, Cognizant, FlexTech, HCL, and Infosys, for professional services to support various strategic initiatives.
Background: Staff requests approval to execute contracts with the following existing key vendors: Cognizant, FlexTech, HCL, and Infosys for ongoing and new professional services for L.A. Care’s Information Technology (IT) Department. Each contract will be for $1,500,000, with the total for the four not to exceed $6,000,000.
Additional staff is needed to manage ongoing and new strategic projects such as the Health Benefit Exchange (HBEX), extension of the ICD-10 implementation, and Authorizations, which is the analysis of the current ELDA process for both Managed Health Care (MHC) and Clinical Care Advance (CCA) systems. The professional services are imperative to ensure continuity and completion of projects currently underway, as well as ongoing system maintenance and enhancements.
All of the vendors have the experience and knowledge of L.A. Care’s systems and requirements, possess an extensive resource pool, have irreplaceable historical project knowledge required to meet critical project milestones, are considered preferred, and have proven to be instrumental in L.A. Care’s ongoing initiatives and new strategies. There is an immediate need for professional resources to maintain project continuity, support the existing project work load, and ensure timely project implementations.
Total budget impact of this recommendation is $6 million, based on the Information Technology (IT) Department spend estimate for FY 2014-15.
L.A. Care will be negotiating Master Services Agreements with each of these vendors. These agreements will include a newly created Work Order and hourly billing Rate Card, which together will ensure L.A. Care’s prior authorization of work, the use of competitive rates, and the transparency of billed hours when using services from these vendors.
The intent is for these vendors to become part of L.A. Care’s preferred vendor list in FY 2015-16, to allow for the necessary resources to be available for new projects that will be starting in the current fiscal year.
Budget Impact: Sufficient budget savings in the Information Technology Division from Strategic Projects will fund this request for FY 2014-15. Motion: To authorize staff to contract with the following existing key vendors: Cognizant for an amount not to exceed $1,500,000, FlexTech for an amount not to exceed $1,500,000, HCL for an amount not to exceed $1,500,000, and Infosys for an amount not to exceed $1,500,000 for professional services through September 30, 2015.
28
Board of Governors MOTION SUMMARY
Date: June 4, 2015 Motion No. FIN 108.0615
Committee: Finance & Budget Chairperson: Michael Rembis
Issue: To procure licenses from TriZetto to support configuration environments for QNXT. Background: As the Core System Project (CSP) progresses and with additional projects such as ICD-10 occurring simultaneously, there is a growing need to manage many QNXT configuration environments to support production, upgrades, development, Quality Assurance (QA), and User Acceptance Testing (UAT). Synchronizing numerous environments is a highly manual process and is also time consuming which is adding delays to both CSP and ICD-10.
Staff would like to procure licenses from TriZetto which includes two toolkits that can automate systems processes. Total amount requested is $368,775, based on projected future membership.
Configuration Migration Utility for QNXT (“CMU”) - four year license fee totaling an estimated $184,387 Configuration Maintenance Tool for QNXT (“CMT”) - four year license fee totaling an estimated $184,387
A request for proposal was not conducted for these services because this technology is proprietary to TriZetto corporation, and they are the only option for the migration and maintenance of multiple QNXT environments.
Budget Impact: Sufficient funds are budgeted in the Information Technology Department for FY 2014-15, and will be requested for in subsequent fiscal years, from FY 2015-16 through FY 2018-19.
Motion: To approve funds not to exceed $368,775 for the purchase of the TriZetto Configuration Migration Utility and Configuration Maintenance Tool for QNXT.
29
Board of Governors MOTION SUMMARY
Date: June 4, 2015 Motion No.: COM 100.0615
Committee: Compliance & Quality Chairperson: G. Michael Roybal, MD, MPH
Issue: Approval of L.A. Care’s Revised 2014 Compliance Auditing and Monitoring Plan.
Background:
Revised 2014 Compliance Auditing and Monitoring Plan (now entitled 2015 Audit Work Plan) The audit plan has been updated to incorporate material information that has come to L.A. Care’s attention since the time of the approval of the last audit work plan. They include Center for Medicare and Medicaid Services’ Program Audit findings, memorandum of Best Practices issued on August 27, 2014 and 2015 Readiness Checklist for Medicare-Medicaid Plans. Furthermore, recognizing that L.A. Care no longer services the D-SNP line of business as of January 1, 2015, standards and other thresholds reflected in the updated work plan are now more generally oriented towards those of Cal MediConnect and Medicare. Incorporating new information into the work plan helps ensure relevance of the areas to be audited and is consistent with the mandates of L.A. Care’s Compliance Program and CMS’ rules for an effective internal auditing and monitoring program.
Budget Impact: None
Motion: To approve L.A. Care’s revised 2014 Compliance Audit Work Plan, as submitted.
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For questions about the updated audit work plan, please contact:
Denise Corley Compliance Officer (213)694-1250, ext. 4292 [email protected]
Jonathan Ro Director, Medicare Compliance (213)694-1250, ext. 5948 [email protected]
32 2015
Audit Work Plan
33 2015 Audit Work Plan
Table of Contents I. Background...... 4 II. Audit Methodology ...... 4 III. Audit Team ...... 4 1. Coverage Determination Appeals and Grievances (CDAG) – Effectuation Timeliness...... 5 A. Timeliness of Notification of Coverage Determination ...... 5 B. Written Approval Letter for Coverage Determination or Redetermination Request...... 5 C. Effectuation of Approvals through the End of the Sponsor Year ...... 5 D. Accurate and Full Explanation of the Conditions of Approval...... 5 2. Coverage Determination Appeals and Grievances (CDAG) – Clinical Decision Making ...... 5 A. Adequate or Correct Rationale in Adverse Determination (Denial) Letters...... 5 B. Appropriate Auto-Forwarding of Untimely Coverage Determinations to IRE...... 6 C. Written Denial Letters for Standard or Expedited Coverage Determinations or Redetermination Request...... 6 D. Outreach to Prescriber or Beneficiary To Obtain Additional Information Needed to Render an Appropriate Clinical Decision...... 6 E. Appropriateness of Coverage Determination Denials...... 6 F. Correct Classification of Redeterminations ...... 7 G. Knowledgeable and Qualified Staff...... 7 H. Rights of Enrollees...... 7 I. Oversight of Delegated Functions...... 7 3. Coverage Determination Appeals and Grievances (CDAG) – Grievances ...... 7 A. Oral Coverage Determination Request...... 8 B. Promptly and Appropriately Addressing Grievance Concerns ...... 8 C. Processing Reimbursement Requests as Coverage Determinations ...... 8 D. Effectuating Prior Authorization and Exception Requests...... 8 4. Organization Determination Appeals and Grievances (ODAG) – Effectuation Timeliness...... 8 A. Timeliness of Notification of Organization Determination...... 8 B. Timeliness of Notification of Expedited Organizational Determinations ...... 9 5. Organization Determination Appeals and Grievances (ODAG) – Clinical Decision Making ...... 9
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34 A. Providing Written Notice of Payment Denials...... 9 B. Description of Appeals Process Included in Remittance Advice/Notice (Non-Contracted Providers)...... 9 C. Appropriate Denials of Service ...... 9 D. Denial Letter Content...... 10 E. Enrollee Notification of Right to File Grievance Regarding Sponsor Self-Granted Extensions to Standard Determination Deadlines ...... 10 F. Demonstrated Outreach to Provider and/or Beneficiary When Additional Information Is Needed to Make Appropriate Clinical Decisions ...... 10 6. Organization Determination Appeals and Grievances (ODAG) – Grievances ...... 10 A. Promptly and Appropriately Addressing Grievance Concerns ...... 10 7. Organization Determination Appeals and Grievances (ODAG) – Dismissals ...... 11 A. Process for Dismissing Reconsideration Requests When Appropriate...... 11 B. Reconsideration Timeframes...... 11 8. Systems, Data, and Connectivity ...... 11 A. Systems and Reports...... 11 B. Prescription Drug Event (PDE) ...... 11 9. Reporting...... 12 A. Reporting Systems and Requirements...... 12 10. Contracting, Subcontractor Provisions, and Oversight ...... 12 A. FDR Contract Changes...... 12 11. Customer Service...... 12 A. Customer Service Accessibility...... 12 B. Complaint Tracking ...... 13 12. Marketing ...... 13 A. Materials and Website Requirements ...... 13 13. Enrollment/Disenrollment...... 13 A. Enrollment Processing ...... 13 14. Benefits Administration and Beneficiary Protections...... 13 A. Beneficiary Benefits and Protections...... 13 B. Quality Improvement Programs ...... 14 15. Best Available Evidence (BAE) and Low Income Subsidy (LIS) ...... 14
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35 A. BAE Policy...... 14 B. LIS Benefit Administration ...... 14 16. Coordination of Benefits and TrOOP Balance Transfer...... 14 A. Coordination of Benefits (COB) Data Report/File Processing...... 14 B. TrOOP Balance Transfer (TBT), Financial Information Reporting (FIR), and Member Reimbursement...... 15 17. Claims Processing and Transition Process...... 15 A. Claims Processing...... 15 B. Transition Process...... 15 18. Health Risk Assessments, ICP, and Care Coordination...... 15 A. Risk Stratification ...... 15 B. Health Risk Assessment (HRA) and Individualized Care Plan (ICP) ...... 15 C. Continuity of Care ...... 16 19. Provider Network...... 16 A. Network Adequacy and Requirements...... 16 Appendix 1 (2015 Audit Calendar) ...... 17
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36 I. Background
This is the 2015 Audit Work Plan of the Regulatory Affairs & Compliance department of L.A. Care Health Plan. It summarizes areas identified for review during the current year as relating to the Medicare-Medicaid Plan (MMP), also known as “Cal MediConnect.” It is intended to meet the requirement to develop an audit work plan and conduct audits in accordance with it as expressed in L.A. Care’s Compliance Program and in applicable sections of the Code of Federal Regulations and CMS guidelines.
Information considered in the development of the audit work plan included the CMS 2014 Program Audit, CMS manuals and memos, the Cal MediConnect three-way contract (between CMS, the California Department of Health Care Services (DHCS) and L.A. Care), and previously identified or known risks. The audit work plan may be updated as additional areas for review are identified.
II. Audit Methodology
Audits will be performed in accordance with existing L.A. Care audit and monitoring policies and procedures, which include timeframes for the conducting of entrance and exit meetings and the performance of audit field work. Audit procedures may include the conducting of interviews, reviewing of records, testing of samples, and any other combination of procedures intended to elicit effective findings. Written reports will be provided at the conclusion of audits and include request for corrective action when deemed necessary.
III. Audit Team
The audit team consists of three full-time FTEs, whose formal titles are Senior Compliance Advisor (one FTE) and Internal Audit Compliance Advisor (two FTEs). These advisors are primarily responsible for conducting the audits, but may also have other non-audit duties in their more general role as advisors. Professionals with specialized skills may also participate in the audit when deemed necessary to address particular sections of an audit.
Questions or comments relating to this audit work plan may be directed to:
Denise Corley Compliance Officer (213)694-1250, ext. 4292 [email protected]
Jonathan Ro Director, Medicare Compliance (213)694-1250, ext. 5948 [email protected]
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37 1. Coverage Determination Appeals and Grievances (CDAG) – Effectuation Timeliness
A. Timeliness of Notification of Coverage Determination We will review coverage determination and redetermination cases to determine whether L.A. Care or its PBM notified the beneficiary or their prescriber, as appropriate, of its decision within 72 hours (standard) or 24 hours (expedited) of receipt of the coverage determination request, or, for an exceptions request, the physician’s or other prescriber’s supporting statement. (Findings 4.3.1.1 and 4.3.1.4, 2014 Program Audit; Page 7, CMS Memo August 27, 2014; 42 CFR 423.568(b); 42 CFR 423.572(a); 42 CFR 423.572(b); Medicare Prescription Drug Benefit Manual, Chapter 18, Sections 40.2, 40.3.3, 40.3.4, 40.3.5, and 50.4)
B. Written Approval Letter for Coverage Determination or Redetermination Request We will review coverage determination and redetermination cases to determine whether L.A. Care or its PBM provided written approval letters for standard or expedited coverage determination or redetermination requests. (Finding 4.3.1.2, 2014 Program Audit; 42 CFR 423.572(b); 42 CFR 423.572(b); 42 CFR 423.572(c)(1); 42 CFR 423.590(h); Medicare Prescription Drug Benefit Manual, Chapter 18, Sections 40.3.5, 50.5.2, 70.9.2, and 70.9.4)
C. Effectuation of Approvals through the End of the Sponsor Year We will review coverage determination and redetermination cases to determine whether L.A. Care or its PBM effectuated approvals through the end of the year. (Finding 4.3.1.3, 2014 Program Audit; 42 CFR 423.572(b); 42 CFR 423.572(b); 42 CFR 423.572(c)(1); 42 CFR 423.578(c)(3); 42 CFR 423.478(c)(4); Medicare Prescription Drug Benefit Manual, Chapter 18, Sections 30.2 and 130)
D. Accurate and Full Explanation of the Conditions of Approval We will review coverage determination and redetermination cases to determine whether L.A. Care or its PBM provided accurate or full explanations of conditions of approval in its coverage determination notifications to the beneficiary. The review will include whether letters generated for prior authorization contained approval end dates and that they do not contain conflicting information. (Finding 4.3.1.5, 2014 Program Audit; Page 6, CMS Memo August 27, 2014; 42 CFR 42.568(e); 42 CFR 423.572(c)(1); 42 CFR 423.590(h); Medicare Prescription Drug Benefit Manual, Chapter 18, Section 40.3.5)
2. Coverage Determination Appeals and Grievances (CDAG) – Clinical Decision Making
A. Adequate or Correct Rationale in Adverse Determination (Denial) Letters We will review coverage determination cases to determine whether denial letters included adequate rationale or contained incorrect information specific to the denial. We may engage clinically trained individuals to assist in this review. In its 2014 Program Audit, CMS found
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38 sample cases showing that L.A. Care did not explain why the requested medication was denied, that L.A. Care stated that beneficiary had to be on concurrent medication which did not adhere to the CMS approved criteria for the medication, and that L.A. Care incorrectly stated in the denial letter that the beneficiary was not enrolled in a counseling program when it did not have the information available to make that assessment. (Finding 4.3.2.1, 2014 Program Audit; Page 6, CMS Memo August 27, 2014; 42 CFR 423.568(g); 42 CFR 423.572(c)(2); 42 CFR 423.590(g); Medicare Prescription Drug Benefit Manual, Chapter 18, Sections 40.3.4, 50.5.1, 70.9.1, and 70.9.3)
B. Appropriate Auto-Forwarding of Untimely Coverage Determinations to IRE We will review coverage determination cases denied for untimeliness to determine whether such cases were appropriately forwarded to the IRE for review and disposition. In its 2014 Program Audit, CMS found sample cases showing that L.A. Care did not appropriately auto- forward untimely denied coverage requests to the IRE. (Finding 4.3.2.2, 2014 Program Audit; Page 7, CMS Memo August 27, 2014; 42 CFR § 423.568(h); 42 CFR § 423.572(d); Medicare Prescription Drug Benefit Manual, Chapter 18, Sections 40.4, 50.6, 70.30, and 70.40)
C. Written Denial Letters for Standard or Expedited Coverage Determinations or Redetermination Request We will review coverage determination and redetermination request cases to determine whether written denial letters were provided to the beneficiary and provider. In its 2014 Program Audit, CMS found a sample case in which it could not be verified that a written redetermination denial letter was provided to the beneficiary. (Finding 4.3.2.3, 2014 Program Audit; 42 CFR § 423.568(f); 42 CFR § 423.590(g); Medicare Prescription Drug Benefit Manual, Chapter 18, Section 10.3.2; Medicare Prescription Drug Benefit Manual, Chapter 18, Sections 40.3.4, 50.5.1, 70.9.1, and 70.9.3)
D. Outreach to Prescriber or Beneficiary To Obtain Additional Information Needed to Render an Appropriate Clinical Decision We will review coverage determination cases to determine whether appropriate outreach was conducted to obtain additional information when such information is needed for an adequate review of clinical information. In its 2014 Program Audit, CMS found a sample case demonstrating that L.A. Care did not have adequate controls in place to ensure appropriate outreach is conducted to obtain additional information. (Finding 4.3.2.4, 2014 Program Audit; Page 7, CMS Memo August 27, 2014; 42 CFR § 423.566(a); 42 CFR § 423.586; Medicare Prescription Drug Benefit Manual, Chapter 18, Sections 10.2, 30.2.1.3, 30.2.2.3, 70.5, and 70.7)
E. Appropriateness of Coverage Determination Denials We will review coverage determination denial cases to determine whether the coverage determinations were appropriately denied. In its 2014 Program Audit, CMS found a sample case demonstrating that L.A. Care did not have an effective process to review and consider all information to make a correct clinical decision before denying a coverage request. (Finding 4.3.2.5, 2014 Program Audit; Page 7, CMS Memo August 27, 2014; 42 CFR § 423.566(a); 42 CFR § 423.566(b); Medicare Prescription Drug Benefit Manual, Chapter 18, Section 30)
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39 F. Correct Classification of Redeterminations We will review coverage determination cases to determine whether requests were correctly identified and classified. In its 2014 Program Audit, CMS found a sample case processed as a coverage determination where the beneficiary’s request included a copy of documents that were submitted with a previously denied coverage determination. (Finding 4.3.2.6, 2014 Program Audit; Page 6, CMS Memo August 27, 2014; 42 CFR § 423.580; Medicare Prescription Drug Benefit Manual, Chapter 18, Sections 30, 40.3.4, and 70.2)
G. Knowledgeable and Qualified Staff We will review the organization’s policies and procedures to determine whether they include guidance on adequate, knowledgeable and qualified staff; and whether it describes the processing of coverage determinations and appeals that comply with CMS and plan coverage rules. We will also assess whether applicable employees, which include staff involved with initial coverage decisions, appeals, and grievances, and customer service representatives, are trained in Part C and Part D processes as applicable for an MMP. (Pages 24-25, CMS Memo November 18, 2014, “2015 Readiness Checklist for Medicare- Medicaid Plans”; 42 C.F.R. §§ 422.562, 422.566, 423.562, 423.566; HPMS memos 8/27/2014, 4/28/2014)
H. Rights of Enrollees We will assess applicable policies and procedures and other documents to determine whether Part D benefits enrollees are provided immediate access to the coverage determination and redetermination processes via a toll-free phone number and website. We will also review the organization’s PBM oversight program to determine whether its scope includes examination of whether the PBM’s Part D Systems are properly transmitting codes to network pharmacies that instruct the pharmacies to provide enrollees with a notice at point of sale in certain circumstances where the prescription cannot be filled under the Part D benefit. We will also determine whether Part C reconsideration dismissal procedures have been properly implemented. (Pages 25-26, CMS Memo November 18, 2014, “2015 Readiness Checklist for Medicare- Medicaid Plans”; State-specific Three-way Contract, Medicare Prescription Drug Benefit Manual, Chapter 18; Medicare Managed Care Manual, Chapter 13; HPMS memo 9/10/2013)
I. Oversight of Delegated Functions We will review the organization’s PBM oversight program to determine whether it includes review of functions delegated to the PBM, and whether the oversight program is occurring, including implementation of corrective actions for identified issues, and reporting of the same to the Contract Management Team. (Page 26, CMS Memo November 18, 2014, “2015 Readiness Checklist for Medicare-Medicaid Plans”)
3. Coverage Determination Appeals and Grievances (CDAG) – Grievances
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40 A. Oral Coverage Determination Request We will review coverage determination and redetermination requests to determine whether L.A. Care and its PBM adhered to required procedures for the receipt and handling of oral coverage determination requests. The CMS 2014 Program Audit found that L.A. Care representatives were not properly trained to recognize when and how a coverage determination should be initiated. CMS further found that the pharmacy department failed to initiate the coverage determination request when referred to them from the customer service department on behalf of the beneficiary. (Finding 4.3.3.1, 2014 Program Audit; 42 CFR 423.568(a); 42 CFR 423.570(b); 42 CFR 423.570(c)(1-2); Medicare Prescription Drug Benefit Manual, Chapter 18, Sections 40.1, and 50.1)
B. Promptly and Appropriately Addressing Grievance Concerns We will review grievance cases to determine whether a full investigation was conducted and all issues raised in the grievance addressed. The CMS 2014 Program Audit revealed that investigators were not properly trained to determine if a beneficiary might be eligible for a low- income subsidy (LIS), lower LIS level, or could qualify for a lower co-payment through tiering exceptions. (Finding 4.3.3.2, 2014 Program Audit; 42 CFR § 423.564(a); Medicare Prescription Drug Benefit Manual, Chapter 18, Section 20.3)
C. Processing Reimbursement Requests as Coverage Determinations We will review claims to determine whether beneficiary requests for reimbursement were properly processed as coverage determinations. The CMS 2014 Program Audit found that reviewers did not recognize how and when a coverage determination should be issued. The audit also revealed that the pharmacy department procedures did not ensure beneficiaries were advised how to submit a written request for reimbursement. (Finding 4.3.3.3, 2014 Program Audit; 42 CFR § 423.566(b)(1); 42 CFR § 423.568(b); 42 CFR § 423.568(c); 42 CFR § 423.568(g); Medicare Prescription Drug Benefit Manual, Chapter 18, Section 30.3)
D. Effectuating Prior Authorization and Exception Requests We will review prior authorization and exception request cases to determine whether the requests were appropriately effectuated. In the CMS 2014 Program Audit, it was found that coverage requests that required additional information were not tolled, and instead issued a one-time authorization, closed the case and asked the providers to resubmit the request. (Finding 4.3.3.4, 2014 Program Audit; 42 CFR § 423.120(b)(2); Medicare Prescription Drug Benefit Manual, Chapter 6, Section 30.2.2; CMS Part D Utilization Management Policies and Requirements Memo, HPMS, October 22, 2010, page 2)
4. Organization Determination Appeals and Grievances (ODAG) – Effectuation Timeliness
A. Timeliness of Notification of Organization Determination We will review organization determination cases to determine whether L.A. Care notified the beneficiary or the provider, as appropriate, of its decision within 14 calendar days of receipt of a standard organization determination request.
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41 (Finding 4.4.1.1, 2014 Program Audit; Page 9, CMS Memo August 27, 2014; 42 CFR 422.568(b); Medicare Managed Care Manual, Chapter 13, Section 40.1, Paragraph 1)
B. Timeliness of Notification of Expedited Organizational Determinations We will review expedited organization determination cases to determine whether the beneficiary or provider, as appropriate, was notified of expedited organization determination decisions within 72 hours of receiving the expedited organizational determination request. The CMS 2014 Program Audit identified a sample case that some components of an expedited request, submitted on a single request form, were processed separately and not expedited. The audit also revealed that a process requiring L.A. Care’s final approval of delegate approvals caused the adjudication of expedited requests to exceed the expedited organization determination timeframes in some instances. Lastly, the audit found that insufficient holiday staffing created delays in providing expedited organizational determination notices. (Finding 4.4.1.2, 2014 Program Audit; Page 9, CMS Memo August 27, 2014; 42 CFR § 422.572(a); Medicare Managed Care Manual, Chapter 13, Sections 50.1, Paragraph 1, Bullet 3 and 50.4, Paragraph 1, Bullet 1)
5. Organization Determination Appeals and Grievances (ODAG) – Clinical Decision Making
A. Providing Written Notice of Payment Denials We will review payment denial cases to determine whether the beneficiary or provider, as appropriate, received written notice of determinations to deny payment in whole or in part. The CMS 2014 Program Audit found that a process of generating denial letters providing beneficiaries with information pertaining to their appeal rights or potential liability had not been implemented. The audit also concluded that there was insufficient internal monitoring and oversight of FDR universe submission accuracy. (Finding 4.4.2.1, 2014 Program Audit; Page 9, CMS Memo August 27, 2014; 42 CFR § 422.568(d)(1); Medicare Managed Care Manual, Chapter 13, Sections 40.1, Paragraph 3, 40.2.1, and 40.2.3)
B. Description of Appeals Process Included in Remittance Advice/Notice (Non-Contracted Providers) We will review denied requests for payment from non-contracted providers to determine whether appeal language, including a description of the appeals process, is included in the remittance advice/notice. The CMS 2014 Program Audit concluded that L.A. Care did not have a system for including non-contracted provider appeal language in remittance advice. (Finding 4.4.2.2, 2014 Program Audit; Page 9, CMS Memo August 27, 2014; Medicare Managed Care Manual, Chapter 13, Section 40.2.3)
C. Appropriate Denials of Service We will review cases of beneficiary service denials and provider payment for services rendered to beneficiaries to determine whether the denials were appropriate. The CMS 2014 Program Audit determined that an organizational determination request from a contracted provider was inappropriately denied because medical information and records were not received; a pre- service organizational determination request was denied an evaluation recommended rather than an extension granted to perform the evaluation; payment requests were inappropriately
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42 denied for no authorization; a payment request was inappropriately denied for lack of all required information; and inappropriate criteria were used to render a decision on a pre-service request. (Finding 4.4.2.3, 2014 Program Audit; Page 9, CMS Memo August 27, 2014; 42 CFR § 422.101(a); 42 CFR § 422.101(b); Medicare Managed Care Manual, Chapter 4, Section 10.2)
D. Denial Letter Content We will review organizational determination denial letters to determine whether the denial notices included an adequate rationale, information specific to the denial, and were written in language easily understandable to the beneficiary. In the 2014 CMS Program Audit, sample cases revealed that denial notices did not include the criteria utilized for the denial and lacked denial-specific information. (Finding 4.4.2.4, 2014 Program Audit; Page 9, CMS Memo August 27, 2014; 42 CFR § 422.568(d); Medicare Managed Care Manual, Chapter 13, Section 40.2.2, Paragraphs 1 and 3)
E. Enrollee Notification of Right to File Grievance Regarding Sponsor Self- Granted Extensions to Standard Determination Deadlines We will review grievance cases where L.A. Care granted itself an extension to the standard determination deadline to determine whether the form letter notifying beneficiaries of the extension to the determination deadline contains information explaining the beneficiary's right to file a grievance if s/he disagrees with the decision to grant an extension. (Finding 4.4.2.5, 2014 Program Audit; 42 CFR § 422.568(b); Medicare Managed Care Manual, Chapter 13, Sections 20.4 and 40.1, Paragraph 2)
F. Demonstrated Outreach to Provider and/or Beneficiary When Additional Information Is Needed to Make Appropriate Clinical Decisions We will review organizational determination cases to determine whether appropriate outreach was conducted to obtain additional information when such information is needed for an adequate review of clinical information. The 2014 Program Audit found that L.A. Care did not make reasonable and diligent effort to obtain and clarify all necessary medical information from the provider prior to denying requests. Additionally, the audit revealed that L.A. Care was unable to provide documentation of outreach to providers for obtaining or clarifying information necessary to process an organization determination. (Finding 4.4.2.6, 2014 Program Audit; Page 9, CMS Memo August 27, 2014; Medicare Managed Care Manual, Chapter 4, Sections 110.4, 70.7.1, Paragraph 2, and 70.7.2, Paragraph 1)
6. Organization Determination Appeals and Grievances (ODAG) – Grievances
A. Promptly and Appropriately Addressing Grievance Concerns We will review grievance cases to determine whether a full investigation was conducted and all issues raised in the grievance addressed. The CMS 2014 Program Audit found that beneficiaries' grievances were not fully identified and/or investigated, and the resolution did not address all grievances.
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43 (Finding 4.4.3.1, 2014 Program Audit; Page 10, CMS Memo August 27, 2014; Medicare Managed Care Manual, Chapter 13, Section 20.3, Paragraph 2, Bullet 6)
7. Organization Determination Appeals and Grievances (ODAG) – Dismissals
A. Process for Dismissing Reconsideration Requests When Appropriate We will review reconsideration request dismissals to determine whether the dismissals were appropriately processed and whether timely notification of the dismissal was provided to the beneficiary (or other appropriate parties). The CMS 2014 Program Audit found that L.A. Care failed to implement processes for dismissing reconsideration requests when appropriate, and instead incorrectly sent cases to the IRE to be dismissed rather than dismissing them internally and issuing notices to the impacted parties outlining appeal rights and the reason for the dismissal. (Finding 4.4.4.1, 2014 Program Audit; Change in Part C Reconsideration Dismissal Procedures - HPMS Memo 9/10/2013; Part C Reconsideration Dismissal Procedures – Model Dismissal Notice - HPMS Memo 10/30/2013)
B. Reconsideration Timeframes We will review reconsideration request dismissals to determine whether the correct reconsideration timeframe was applied. The CMS 2014 Program Audit found that non- contracted providers’ appeals were dismissed prematurely, as the requests were forwarded to the IRE after 30 days, rather than remaining open for 60 days. (Finding 4.4.4.2, 2014 Program Audit; Page 10, CMS Memo August 27, 2014; Medicare Managed Care Manual, Chapter 13, Sections 10.4.1, Paragraph 8 and 60.1.1)
8. Systems, Data, and Connectivity
A. Systems and Reports We will determine whether applicable departments have appropriate access to and are utilizing required systems and reports, including the Health Plan Management System (HPMS), MARx, Electronic Correspondence Reporting System (ECRS), Medicare Plan Finder (MPF) Communications website, Patient Safety Analysis website, Overutilization Monitoring System (OMS), Acumen websites, and Risk Adjustment Processing System (RAPS). (Pages 3-8, CMS Memo November 18, 2014, “2015 Readiness Checklist for Medicare-Medicaid Plans”)
B. Prescription Drug Event (PDE) We will review and document the organization’s processes for the administration of prescription drug event (PDE) data, including those relating to submission, testing and certification. We may conduct sampling procedures to verify PDE processes are performing as intended, including those of delegates, such as the PBM, to which any such processes are delegated. (Pages 3-8, CMS Memo November 18, 2014, “2015 Readiness Checklist for Medicare-Medicaid Plans”); 42 CFR § 423.322(a); Section 2.13.6, Schedule 2 of Navitus Health Solutions, LLC PBM Service Agreement)
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44 9. Reporting
A. Reporting Systems and Requirements We will determine whether timely and accurate submissions are occurring of required reports, including MMP Core Reporting Requirements and California-specific reporting measures, Health Effectiveness and Data and Information Set (HEDIS), Health Outcomes Survey (HOS), and Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures. We will also determine whether the organization is meeting Part C and Part D reporting requirements, including all applicable MMP Core Reporting and State-specific reporting measures. (Page 8, CMS Memo November 18, 2014, “2015 Readiness Checklist for Medicare-Medicaid Plans”; HPMS memo 06/11/2013; HPMS email 3/7/2013; Plan Reporting Sites: http://www.cms.hhs.gov/HealthPlansGenInfo/16_ReportingRequirements.asp#TopOfPage and http://www.cms.gov/Medicare/Prescription-Drug- Coverage/PrescriptionDrugCovContra/RxContracting_ReportingOversight.html)
10. Contracting, Subcontractor Provisions, and Oversight
A. FDR Contract Changes We will assess whether downstream contracts for Medicare services meet CMS requirements. The CMS requirements include that Contract Management Team is notified of any changes to First Tier, Downstream, or Related Entity (FDR) contracts at least 60 days prior to the effective date of the new contract; that any new systems involved have been fully tested and are fully functional; and in the case of Pharmacy Benefit Manager changes, that all CMS-mandated steps have been followed, and all members’ 4Rx data updated. (Pages 8-9, CMS Memo November 18, 2014, “2015 Readiness Checklist for Medicare-Medicaid Plans”; Medicare Managed Care Manual, Chapter 2, Section IV(D)(a); Medicare Prescription Drug Benefit Manual, Chapter 3, Section IV(D)(a); February 2014 NCPDP white paper, “Part D Plans Moving Processors V.4.0,” http://www.ncpdp.org/Resources/Medicare-Part-D)
11. Customer Service
A. Customer Service Accessibility We will determine whether call center has been staffed according to management’s expectations, including whether the staffing model incorporates periods of increased volume; whether the call center is available to members and prospective enrollees during the CMS- defined “usual business hours”; whether pharmacy technical support is available at all times any network pharmacy is open; whether interpreter services are available to all call center employees; whether call center staff are sufficiently knowledgeable about the Medication Therapy Management (MTM) program, the Best Available Evidence (BAE) process, and can assist or refer beneficiaries with complaints and coverage determination requests. (Pages 9-11, CMS Memo November 18, 2014, “2015 Readiness Checklist for Medicare-Medicaid Plans”; Medicare Marketing Guidelines and State-specific Marketing Guidance, Sections 30.5, 30.5.1, 100.1, and Appendices 3 and 5; 42 C.F.R. §§ 422.2264(e), 423.2264(e)); HPMS memo 9/09/2014)
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45 B. Complaint Tracking We will assess whether of Complaints Tracking Module (CTM) complaints are resolved within the required timeframes. We will also verify that the CMS-developed complaint form is prominently displayed on the L.A. Care websites, and contains direct links to www.Medicare.gov and the website of the Medicare Ombudsman. (Page 11, CMS Memo November 18, 2014, “2015 Readiness Checklist for Medicare-Medicaid Plans”; HPMS memos 6/28/2013, 12/22/2011, and 11/10/2011; 42 CFR §§ 422.504 and 423.505)
12. Marketing
A. Materials and Website Requirements We will determine whether basic services and information are available to individuals with disabilities upon request, and that plan materials and information is available in alternative formats upon request. We will also verify the accurate and timely mailing of the Annual Notice of Change (ANOC) and Evidence of Coverage (EOC)/Member Handbook. We will also verify that the L.A. Care websites contain the required information, content, and documents, including a consistently-updated formulary. (Pages 11-12, CMS Memo November 18, 2014, “2015 Readiness Checklist for Medicare- Medicaid Plans”; HPMS memo 09/09/2014, Medicare Marketing Guidelines and State-specific Marketing Guidance, Sections 30.3, 60.5, 60.7, and 100)
13. Enrollment/Disenrollment
A. Enrollment Processing We will determine whether all required materials are sent to new enrollees. We will also review applicable records to determine whether plan data is submitted by due dates, whether there is a process in place to transmit sponsor-generated enrollment transactions that include active 4Rx data, and for state-generated enrollments, to transmit active 4Rx data on an update transaction within 72 hours of availability of the TRR transmitting the enrollments. (Pages 13-14, CMS Memo November 18, 2014, “2015 Readiness Checklist for Medicare- Medicaid Plans”; Plan Communications User Guide; 42 C.F.R. § 423.32(c))
14. Benefits Administration and Beneficiary Protections
A. Beneficiary Benefits and Protections We will review applicable records to determine compliance with requirements regarding Explanation of Benefits delivery; maintenance of written policies and procedures regarding advance directives; and disenrollment of beneficiaries who reside outside of L.A. Care’s service area beyond a specified period of time. We will also, after June 1, 2015, determine whether physicians and eligible professionals who prescribe covered Part D drugs are either enrolled in Medicare or have a valid record of opting out of Medicare. (Page 14, CMS Memo November 18, 2014, “2015 Readiness Checklist for Medicare-Medicaid Plans”; 42 CFR §§ 422.128, 423.120(c)(6); Medicare Marketing Guidelines; Managed Care Manual, Chapter 4, Sections 70 and 100.7; HPMS memo 4/30/2010)
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46 B. Quality Improvement Programs We will review the QI program to determine whether it meets applicable requirements for the services it furnishes to enrollees. We will determine whether compliance has been met with timeframes and requirements for the initial QIP Plan Section and the QIP Annual Update. (Pages 16-17, CMS Memo November 18, 2014, “2015 Readiness Checklist for Medicare- Medicaid Plans”; 42 CFR §§ 422.152, 438.240; State-specific Three-way Contract; HPMS memos 10/17/2014, 8/01/2014; Medicare Managed Care Manual, Chapter 5)
15. Best Available Evidence (BAE) and Low Income Subsidy (LIS)
A. BAE Policy We will review applicable procedures and other documents to assess the extent of the organization’s compliance with CMS’ BAE policy. (Pages 17-18, CMS Memo November 18, 2014, “2015 Readiness Checklist for Medicare- Medicaid Plans”; HPMS memos 8/04/2008, 10/16/2008; Medicare Prescription Drug Benefit Manual Chapter 13, Sections 70.5, 70.5.3; Section 2.13.7, Schedule 2 of the Navitus Health Solutions, LLC PBM Service Agreement )
B. LIS Benefit Administration We will determine whether the organization is properly administrating the LIS benefit, including whether the correct CMS LIS levels are being applied to enrollees, whether LIS eligible individuals are being reimbursed excess premiums or cost-sharing; whether the state is being notified of corrections needed in the Loss of Subsidy Date File, and whether appropriate action is taken in response to files concerning deeming from CMS, and maintenance of accurate LIS information. (Pages 17-19, CMS Memo November 18, 2014, “2015 Readiness Checklist for Medicare- Medicaid Plans”; HPMS memos 11/30/2009, 7/31/2013, 8/30/2006, 10/30/2006, 11/26/2008, 11/23/2009, and 12/09/2010; Medicare Prescription Drug Benefit Manual Chapter 13, Sections 70.1, 70.3.1, 70.5.6; 42 C.F.R. §§ 423.466, 423.800; Plan Communication Guide (PCUG) Section E18, Loss of Subsidy Data File (http://www.cms.hhs.gov/MMAHelp; HPMS memos); Section 2.13.8, Schedule 2 of the Navitus Health Solutions, LLC PBM Service Agreement )
16. Coordination of Benefits and TrOOP Balance Transfer
A. Coordination of Benefits (COB) Data Report/File Processing We will determine whether the Transaction Facilitator is notified of new contract IDs that should be added under the scope of the existing business associate agreement (BAA). We will also verify the establishment and maintenance of systems and procedures for weekly COB data report/file processing, the correct interpretation of the COB file, and compliance with the COB notification process regarding new or update prescription drug coverage information. We will also verify compliance with recent CMS requirements for hospice and ESRD-eligible beneficiaries. (Pages 19-22, CMS Memo November 18, 2014, “2015 Readiness Checklist for Medicare- Medicaid Plans”; Medicare Prescription Drug Benefit Manual Chapter 14; Medicare Secondary Payer Manual, Chapter 6; Medicare Managed Care Manual, Chapter 4, Section 130; Plan Communication User Guide (PCUG); 2014 Call Letter, Table 5; 2008 Regional Prescription Drug
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47 Event Data Technical Assistance Participant Guide, HPMS memos 11/24/2008, 7/21/2009; Hospice FAQs; 2010 Call Letter and update; 42 C.F.R. §423.466(b))
B. TrOOP Balance Transfer (TBT), Financial Information Reporting (FIR), and Member Reimbursement We will determine whether the organization’s procedures support the correct processing of Information Reporting (Nx or N) transactions received from the Part D Transaction Facilitator; the accurate tracking, accumulation, and reporting of TrOOP for all members; successful resolution of identified TBT problems within 15 days of notification of the problem; and compliance with guidance regarding direct member reimbursement. (Page 22, CMS Memo November 18, 2014, “2015 Readiness Checklist for Medicare-Medicaid Plans”; Medicare Prescription Drug Manual, Chapter 14, Section 50.4.3 and Table 50.4.3-1 and Chapter 18, Section 30.3)
17. Claims Processing and Transition Process
A. Claims Processing We will assess the organization’s program (and, where applicable, the organization’s oversight program over its pharmacy benefit manager (PBM)) as relating to pharmacy point of sale claims processing, preparedness for provider access during Federal Disaster or other Public Health Emergency Declaration, and process for retroactive claims adjustment, refunds and recoveries. (Pages 22-24, CMS Memo November 18, 2014, “2015 Readiness Checklist for Medicare- Medicaid Plans”; Medicare Managed Care Manual, Chapter 4, Section 30.9; Medicare Prescription Drug Benefit Manual, Chapter 5 and Chapter 18, Section 40.3.1; HPMS memo; HPMS memos 6/16/2008, 7/20/2009, 3/25/2010, 8/27/2010, 12/20/2010, 2/17/2011, 11/7/2012; 42 CFR § 423.466(a); State-specific Three-way Contract; 42 C.F.R. § 423.120(b)(3)(v); Medicare Prescription Drug Benefit Manual)
B. Transition Process We will assess the organization’s oversight program over its pharmacy benefit manager (PBM) to determine whether the transition process is operating in accordance with policy and regulatory requirements. (Pages 23-24, CMS Memo November 18, 2014, “2015 Readiness Checklist for Medicare- Medicaid Plans”; Medicare Managed Care Manual, Chapter 4, Section 30.9; Medicare Prescription Drug Benefit
18. Health Risk Assessments, ICP, and Care Coordination
A. Risk Stratification We will review policies and procedures, including review of samples where applicable, to determine whether the organization has an approved health risk stratification mechanism or algorithm to identify new Enrollees with high risk and more complex health care needs. (Section 2.8.1, Three-Way Agreement; DPL 13-002)
B. Health Risk Assessment (HRA) and Individualized Care Plan (ICP) We will determine whether Health Risk Assessments (HRA) were completed for enrollees in all applicable instances. We will also review organization policies and procedures, including sample
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48 plans where appropriate, to determine whether an ICP was developed for each Enrollee and done in accordance with timeliness and other requirements. (Sections 2.8.2, 2.8.3, and 2.5.1.9, Three-Way Agreement; DPL 13-002, DPL 13-004; WIC Section 14182.17(d)(2); CMS Model of Care requirements)
C. Continuity of Care We will review procedures and validate supporting records to determine whether enrollees had continuing access to medically necessary items, services, and medical and LTSS providers. (Section 2.8.4, Three-Way Agreement; DPL 14-004)
19. Provider Network
A. Network Adequacy and Requirements We will review organization records to determine whether the network of providers comply with the required network adequacy thresholds as relating to medical, behavioral health, pharmacy and LTSS, excluding IHSS, providers. We will also assess whether the procedures of the organization are consistent with contractually required obligations, including notifying the CMT of any significant network changes timely, credentialing requirements, linguistic and cultural services, and other obligations. (Section 2.9, Three-Way Agreement; Section 1, Schedule 2 of Navitus Health Solutions, LLC PBM Service Agreement)
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49 Appendix 1 (2015 Audit Calendar)
Section Q1 Q2 Q3 Q4 1 CDAG- Effectuation Timeliness
2 CDAG - Clinical Decision Making
3 CDAG - Grievances
4 ODAG- Effectuation Timeliness
5 ODAG- Clinical DecisionMaking
6 ODAG - Grievances
7 ODAG-Dismissals
8 Systems, Data, and Connectivity
9 Reporting
10 Contracting, Subcontractor Provisions, and Oversight 11 Customer Service
12 Marketing
13 Enrollment/Disenrollment
14 Benefits Administration and Beneficiary Protections 15 Best Available Evidence (BAE) and Low Income Subsidy (LIS) 16 Coordination of Benefits and TrOOP Balance Transfer 17 Claims Processing and Transition Process 18 Health Risk Assessments, ICP, and Care Coordination 19 ProviderNetwork
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50
Board of Governors MOTION SUMMARY
Date: June 4, 2015 Motion No. ECA 100.0615
Committee: Executive Community Advisory Chairperson: Elda Sevilla
Issue: Approval of additional member (s) to the Regional Community Advisory Committees (RCACs) and Coordinated Care Initiative (CCI) Demonstration Project Councils.
Background: Senate Bill 2092 requires that L.A. Care Health Plan ensure community involvement through a Community Advisory Committee. L.A. Care’s Regional Community Advisory Committee (RCAC) structure is composed of 5-35 members per RCAC. RCAC member recruitment is on-going to ensure the highest possible community involvement. L.A. Care Health Plan developed a Memorandum of Understanding (MOU) with the State of California ensuring that seniors and people with disabilities who are participants in the Coordinate Care Initiative (CCI) Demonstration Project also known as CalMedi-Connect are provided an opportunity to participate in L.A. Cares consumer stakeholder committees and processes. The Coordinated Care Initiative (CCI) Consumer Councils structure is composed of up to 11 members to ensure the highest possible community involvement and feedback.
Budget Impact: None.
Motion: To approve the following candidate(s) to the Regional Community Advisory Committees (RCAC), and Coordinated Care Initiative Councils (CCI) as reviewed by the Executive Community Advisory Committee (ECAC) during the May 13, 2015 ECAC meeting.
Name RCAC/CCI Type of Member Area Council # (Agency, if applicable)
Beverly Caples CCI Area 1 Consumer Momshouse (Donna Hill) CCI Area 1 Community Partner Leonid Berman CCI Area 3 Consumer Earnestine Lawson CCI Area 3 Consumer Mary Taylor CCI Area 3 Consumer Lolita Willis CCI Area 3 Consumer Roberto Santos RCAC 3 Consumer Shonovia Escoe RCAC 3 Consumer Higinio Carrillo RCAC 8 Consumer Cruz Martinez RCAC 11 Consumer
51
Board of Governors MOTION SUMMARY
Date: June 4, 2015 Motion No. ECA 101.0615
Committee: Executive Community Advisory Chairperson: Elda Sevilla
Issue: RCAC Vice-Chair Elections.
Background: Per the RCAC/Executive Community Advisory Committee (ECAC) Operating Guidelines, RCAC Vice Chair elections are held once every two years. Per the RCAC Member Handbook, if a Vice -Chairperson resigns the RCAC will have the opportunity to re-elect a Vice- Chairperson. A motion to approve the Vice-Chairperson elect will be submitted to the Board of Governors.
The candidate listed below was elected by members of RCAC 3 as their Vice-Chairperson, during their April 21, 2015 RCAC meeting.
Budget Impact: N/A
Motion: To approve the election of Cynthia Conteas-Wood as Vice Chairperson of the Regional Community Advisory Committee (RCAC) of region 3 to complete the remainder of the term until September 2016 as reviewed by the Executive Community Advisory Committee during the May 13, 2015 meeting.
52 May 29, 2015
TO: Board of Governors
FROM: John Baackes, Chief Executive Officer
SUBJECT: CEO Report – June 2015
The June Board meeting will be my first opportunity to engage the Board of Governors in L.A. Care’s strategic planning process for 2015-2016. During open session, we will have a dialogue on a question that will be shared with Board members in advance. The goal of the discussion will be to create a transparent environment to solicit your input on the value L.A. Care should be adding to our members, providers, and community. This effort is being coordinated with the development of L.A. Care’s fiscal year 2015-2016 operating budget so that the organization’s strategic direction is accounted for in the development of targets and program planning. A discussion guide that further outlines the strategic planning process and the question to be discussed at the June Board meeting is attached to my report. You may want to have this page accessible during the strategic discussion for reference.
Please find below an update on organizational activities that occurred in May 2015. Additional updates will be made at the June 4, 2015 Board meeting.
1. Joint Audit by State Regulators Starting on July 20, the California Department of Health Care Services (DHCS) and Department of Managed Health Care (DMHC) will be conducting an audit of L.A. Care medical services and operations for the period July 1, 2014 to June 30, 2015. All product lines will be reviewed. Staff is diligently preparing to submit documentation in advance of the onsite audit as part of the desk review and will pull the required medical records for any chart reviews. This is a routine review as L.A. Care was audited last year by both regulatory agencies, but will require a significant amount of staff time to prepare appropriately. Additional information regarding this audit is outlined in the Chief Medical Officer’s report.
2. Coordinated Care Initiative Update On May 27, 2015, L.A. Care hosted a quarterly Coordinated Care Initiative Stakeholder Operational Workgroup Meeting. This is a regularly scheduled meeting for advocates, providers, and other stakeholders to learn about how L.A. Care is implementing the Coordinated Care Initiative and Cal MediConnect. Moving forward, staff plans to work with stakeholders to restructure the meetings away from primarily being an informative/educational forum and move into more of an advisory role.
53 3. Leadership Changes at Health Care Trade Associations It was announced this month that Brianna Lierman will become CEO of Local Health Plan of California (LHPC), the trade association publicly-sponsored and nonprofit health plans. Ms. Lierman was previously Vice President of Government Affairs at California Health and Wellness Health Plan (a subsidiary of Centene). L.A. Care is an active member of LHPC.
After 22 years of service, it was announced that Karen Ignagni, President and CEO of America’s Health Insurance Plans (AHIP) is leaving the organization to lead EmblemHealth, a health insurer based in New York. L.A. Care is also a member of AHIP.
4. NCQA Distinction in Multicultural Health Care This month, L.A. Care earned a distinction from the National Committee for Quality Assurance in Multicultural Health Care. I am particularly proud of the organization for achieving this recognition given the diverse membership we serve. With approximately 1.7 million members, meeting their unique needs and providing care that is culturally and linguistically appropriate sets us apart from other health plans. Congratulations to all staff who worked on accomplishing this goal for L.A. Care.
5. Events of Interest RCAC 4 Meeting – During my opening remarks at the RCAC education conference last month, I committed to members and guests that I would attend a meeting in every region. I am pleased that I was able to participate in my first RCAC meeting on May 19, 2015. It was serendipitous that my first RCAC meeting would represent the individuals from the region of my new Southern California home (RCAC 4 - Hollywood, Wilshire, Central LA, Glendale).
LGBTQ Conference – On May 16, 2015, I made remarks at an L.A. Care continuing medical education program on LGBTQ Health. The day-long program was very well attended with positive feedback from the majority of participants. Participants learned about health disparities, State regulations, and different approaches to sensitive conversations for lesbian, gay, bisexual, transgender, and questioning individuals.
Health Promoter Training – In May, L.A. Care hosted several trainings for our Health Promoters Program. Topics covered included diabetes health education and the Active Steps Program. Health promoters also participated in a focus group to support the overall program evaluation.
In addition, I participated in several events and meetings this month including: Venice Family Clinic Art Walk Partners in Care Foundation Awards Event Hospital Association of Southern California Los Angeles Leadership Meeting California Department of Health Care Services All Plan CEO Meeting
Please find attached to my report a listing of events that L.A. Care sponsored in May.
Attachments: June Board meeting strategic discussion guide May sponsorship list
54 Strategic Discussion Guide Board of Governors Meeting - June 4, 2015
Background L.A. Care has changed dramatically over the last decade moving from primarily being a broker/oversight agency with all members enrolled through subcontracted Plan Partners to becoming a health plan with multiple direct lines of business that has experienced rapid membership growth. With the recent stabilization of this growth, L.A. Care has the opportunity to redefine our position in the health care market, refocus our organizational tactics to achieve our desired position, and reinvigorate our organization to maximize performance and success. To accomplish this, we are conducting a strategic planning process to identify where the organization should be in three to five years, the tactics to move the organization in that direction, and the metrics to measure our success.
The input of the Board of Governors is vital to this process. At the June and July Board meetings, we will discuss concepts that will help define L.A. Care’s future position. Staff will incorporate the results of these discussions into a document that defines our strategic direction. L.A. Care leadership and staff will identify tactics and an operational plan to guide implementation. The Strategic Direction document will be discussed at the September Board retreat and once approved, will be incorporated into the fiscal year 2015-2016 operating budget.
The discussion at the June meeting will address the value that L.A. Care offers to our members, and the July meeting will address the value that L.A. Care offers to our providers.
Discussion Guide For the June meeting, Board members will respond to the following questions, first individually (round-robin style) and then as a group.
What value do you and the constituents you represent believe that L.A. Care adds to members, and what value do you think should we add? With the recent changes to L.A. Care and the health care environment, does L.A. Care’s value proposition change and in what direction? How does our role as Local Initiative and supporter of the safety net contribute to the value we provide to members and the community?
55 May 2015 Participation and Sponsorship List
Event Date Organization Event Location
5/3/2015 Estrella TV Cinco de Mayo Whittier Narrows Park
Human Service Association Millennium Biltmore 5/7/2015 Spirit of Service Gala (HSA) Hotel
Valley Presbyterian Annual Celebration of 5/7/2015 Globe Theatre Hospital Excellence
Los Angeles Aging The California 5/8/2015 Summit on Aging Advocacy Coalition Endowment
Vision and Excellence in Partners in Care 5/18/2015 Health Care Leadership Beverly Hilton Hotel Foundation Tribute Dinner
Valley Community Grand Opening Calamigos Equestrian 5/20/2015 Healthcare Party/Casino Royale Center
Venice Art Walk & 5/17/2015 Venice Family Clinic Venice Beach Auction Benefit
South Bay Children's Champions for Children South Coast Botanical 5/30/2015 Health Center Run/Walk Gardens
56 May 29, 2015
To: Board of Governors
From: Gertrude S. Carter, MD, Chief Medical Officer
Subject: CMO Report for June 2015
Department of Health Care Services/Department of Managed Health Care Audit L.A. Care has been selected for a coordinated Department of Health Care Services (DHCS) and Department of Managed Health Care Audit (DMHC) Audit. This is a routine medical audit and the on- site DHCS review will occur from July 20 – July 31, 2015. The DMHC on-site review will occur from July 20 – 24, 2015.
DHCS will be conducting the routine medical audit to evaluate the implementation for Medi-Cal contract requirements excluding requirements for Seniors and People with Disabilities (SPDs). DHCS has contracted with DMHC to conduct the routine review to assess the overall performance in meeting the health care needs of SPDs. DMHC will conduct routine reviews for 1) the implementation of health plan services for all non-Medi-Cal lines of business, which include L.A. Care Covered, PASC- SIEU, Healthy Kids; and, 2) a review of the implementation of the Cal MediConnect Program for Medi-Cal based services.
Both have requested specific information from L.A. Care for the time period July 1, 2014 to June 30, 2015. Health Services is working diligently on both the DHCS and the DMHC portions of the audit to get the information to the regulators. I have assigned Medical Directors to take the lead for utilization management, case management, access, quality improvement, long term supports and services, and grievances and appeals sections of the audit. The new Clinical Assurance department will take a lead role in this audit and is responsible for support and final review of all items submitted by the Medical Directors. I am confident my team will provide the necessary documents for this audit and I will keep the Board updated on our progress.
NCQA Multicultural Health Care Distinction L.A. Care was awarded the National Center for Quality Assurance (NCQA) Multicultural Health Care (MHC) Distinction for its Medi-Cal and L.A Care Covered product lines. This is the second time L.A. Care is being awarded for the Medi-Cal product line and the first time for L.A. Care Covered. With a score of 98.25 out of 100, L.A. Care is recognized as an industry leader in providing culturally and linguistically appropriate services while reducing health care disparities. The award aligns with L.A. Care’s organizational goal of maintaining its NCQA accreditation. We will receive automatic credit for five different factors in the accreditation survey. We continue to be one of seven health plans nationwide to be awarded the MHC Distinction for Medi-Cal, and one of five health plans for California Covered.
57 June Chief Medical Officer Report May 29, 2015
NCQA Member Connections (MEM 8) Standard The new MEM 8 standard requires L.A. Care to conduct targeted outreach to identified members to promote member wellness and prevention. The outreach must include reminders for needed care for a condition or risk factor, reminders about missed services, information about evidence-based guidelines, links to web-based self-management tools, and information about community based resources. An interdepartmental team convened to identify existing member initiatives that comply with MEM 8 standard requirements. The team members are in the process of compiling evidence for the upcoming mock audit, scheduled for May 22, 2015.
Access to Care QI received L.A. Care’s 2014 Timely Access to Care and Availability results. The results include appointment availability and after-hours availability. There has been a decrease in L.A. Care’s score for after-hours performance over the last three years. Despite an aggressive corrective action process in August, September and October, the 2014 results decreased in comparison to 2013. L.A. Care met with all PPGs the week of May 18th and requested immediate corrective action required (ICARs) for the after-hour availability performance that was due May 26th. The corrective action plan (CAP) for appointment availability is due June 8th. We continue to explore strategies that support this PPGs responsibilities in working with PPC practices to improve performance.
HEDIS Operations HEDIS 2015 reports are due to state regulators and to NCQA by June 15, 2015. Preliminary rates indicate improvements for key measures compared to prior years, and most measures have exceeded the minimum performance level (25th percentile), with several measures attaining NCQA’s 75th and 90th percentiles. HEDIS activities (compliance audit and data collection) are still underway. Final rates, reports and analyses will be available after June 15.
Medicare Star We are continuing with Part C and Part D intervention efforts by launching the first in a series of monthly interactive voice response (IVR) refill reminder calls for non-adherent members. The first set of calls was completed in April and results indicated that 31% of calls were a live answer 26% were voicemail messages.
We are re-evaluating Star priority areas and developing additional interventions. Priority areas include Health Outcome Survey measures, Care for Older Adults measures, and Diabetes Care. Our Communications department, in conjunction with an external research group, has conducted a series of focus groups for enrolled and disenrolled CMC members. Results of the focus group will be used to develop member retention and satisfaction interventions.
CMS is continuing its audit of our text telephone (TTY) line. Internal monitoring is done daily as staff is tracking and resolving issues as they arise.
In addition, Medicare-Medicaid Plans (MMP) are subject to national and state-specific quality withhold measures. L.A. Care will be responsible for reporting on these measures for Cal MediConnect. All measures are weighted equally. CMS will release withhold methodology and benchmarks for measures on a rolling basis, and MMPs will receive a “pass” or “fail” for each withhold measure. Several HEDIS, CAHPS, and HOS metrics are included in Demonstration Year 1 through 3. These and all Quality Withhold measures will be closely be monitored by the Medicare Operations department and incorporated into the overall Star work plan.
58 June Chief Medical Officer Report May 29, 2015
Behavioral Health We are hosting activities for internal staff throughout May in recognition of Mental Health Month. Staff conducts brown bag lunch sessions to discuss a variety of behavioral health related topics with the goal to reduce stigma in care.
The March Behavioral Health Stakeholder meeting focused on Substance Use Disorder system of care in L.A. County. The April meeting focused on Antipsychotic Use in Foster Care Children and Evidence Based Practice Guidelines. Both meetings were well attended with over 70 participants. The topic of treatment for foster care children is particularly timely due to the recent recommendation from DHCS for health plans to develop a foster care program looking at overall quality of care for this population.
We hosted an all-day continuing medical education (CME) conference on Early and Period Screening, Diagnostic, and Treatment (EPSDT) on March 21, 2015, and on Palliative Care on April 11, 2015. Both conferences attracted over 300 providers, mainly primary care and nurse practitioners and registered nurses.
Health Information Technology (HIT) Based on learnings from a third-party evaluation of eConsult, eManagement for behavioral health is being enhanced into a broader QI program to improve health outcomes, efficiency and effectiveness, and member and provider satisfaction in identifying and treating conditions. A PCP incentive program for eManagement is being designed. eManagement launch is expected late 2015. An additional program for DSNP authorizations is underway.
Over 1,300 members signed up for Blue Button on the member portal to get their prescription information, using it 3,500 times. The rollout and awareness strategy to all 1.5 million members is being developed. Five solo practices will pilot Blue Button kiosks to allow members to print medication histories onsite for their physicians. The first two kiosks are expected to launch in June.
New Staff I am pleased to welcome Katrina Miller, M.D., as the new Medical Director for Informatics. Dr. Miller is a family physician. Previously, she was Clinical Information Systems Medical Director for Adventist Health West. She trained in Quality Management through ACPE, is a GE Change Agent Plus and has chaired multiple inpatient and ambulatory quality and peer review committees. She is a Diplomat of both the American Board of Family Medicine and the American Board of Preventive Medicine – Clinical Informatics Specialty. Her BA is from Reed College in Portland, Oregon, her MD is from Eastern Virginia Medical School in Norfolk, Virginia and her residency was at UCLA-Westwood. I am pleased to have Dr. Miller join the Health Services team.
59
Board of Governors MOTION SUMMARY
Date: June 4, 2015 Motion No. BOG 101.0615 Committee: Chairperson: Thomas Horowitz, DO
Issue: Amend a contract with Health Integrated to support Los Angeles County Department of Health Services for utilization management (UM) administrative services.
Background: L.A. Care staff seeks approval for the amendment of a contract with Health Integrated to support Los Angeles County Department of Health Services in an amount of $2,000,000, from July 1, 2015 to December 31, 2015 for utilization management (UM) administrative services. Health Integrated will provide outpatient and inpatient utilization management (UM) services to expand L.A. Care's UM capacity to support the Los Angeles County Department of Health Services (DHS). DHS is a contracted L.A. Care participating provider group serving approximately 210,000 members currently in L.A. Care’s directly contracted Medi-Cal line of business (MCLA). Monthly Membership is projected to be around 220,000 members from July 2015 – December 2015.
The contract requires co-management between DHS and L.A. Care for a select set of medical benefits and facility services. Health Integrated will utilize Medi-Cal guidelines, Medi-Cal benefit criteria, applicable evidence based criteria, or any other L.A. Care approved authorization criteria in the performance of all delegated services.
Health Integrated is a management service organization and has achieved National Commission for Quality Assurance certification for utilization management. In July 2012, the Board approved L.A. Care’s initial contract with Health Integrated UM administrative services to process DHS member authorizations. To date, the board has approved a total of $9,802,400 for this contract.
We pay Health Integrated on a PMPM basis. We were able to negotiate the PMPM rate down from $1.67 to $1.50 and this new rate went into effect July 1, 2014. In January 2015, we were able to negotiate the rate down further based on membership level increasing past 220,000 members per month. However, this increase in membership did not manifest and the membership has ranged between 200,000 – 220,000 members the last several months. We anticipate paying $1.50 PMPM for approximately 210,000- 220,000 members from July 1, 2015 – December 31, 2015.
The last amendment extension request was only through June 30, 2015 because L.A. Care planned to bring these UM functions in-house for this population effective July 1, 2015. However, this did not come to fruition due to other higher priority projects that have taken precedence in the department. As a result, we are requesting another 6-month extension through 12/31/15.
Budget Impact: Sufficient funds are budgeted in the Medical Management Department. We intend to reduce DHS’s capitation by the cost of Health Integrated’s services. Motion: To contract with Health Integrated for an amount not to exceed $2,000,0000 from July 1, 2015 to December 31, 2015, for utilization management administrative services to support Los Angeles County Department of Health Services.
60
Board of Governors MOTION SUMMARY
Date: June 4, 2015 Motion No. BOG 102.0615
Committee: Chairperson: Thomas Horowitz, DO
Issue: Approve revisions to the Procurement Policy (AFS-007) and the elimination of the Contract Review and Approval Process Policy (AFS-026).
Background: This Procurement Policy has been previously approved by the Finance & Budget Committee and has been tabled from the past Board of Governors Meeting Agendas because of efforts to address meals and entertainment expenses from the L.A. Care Health Plan Financial Condition Review. The Procurement Policy has no impact on meals and entertainment expenses or the review. It has been updated to reference the new Expense Policy and Travel Expense Policy to direct staff to the proper procedures. L.A. Care’s membership and business has increased dramatically over the recent years, which has directly impacted our operating budget and costs associated with providing services and programs to our members. In support of L.A. Care’s commitment to the promotion of accessible, high quality health care that is driven by continuous improvement and innovation, the updated Procurement Policy combines and improves the Purchase of Products, Services, and Capital Assets policy (AFS-007) and the Contract Review and Approval Process policy (AFS-026) which both originated in 2002 and revised in 2010. The updated Procurement Policy aims to better align procurement with L.A. Care objectives and size; ensure fair and equitable procurement processes; provide better clarity and accountability; mitigate risks in the selection of vendors; and ensure effective use of L.A. Care staff resources. The new policy will replace the current policy AFS-007 and eliminate AFS-026. Summary of changes: The creation of a Procurement Council for better and earlier alignment with the contract and vendor selection needs of each Officer and L.A. Care. Updated definition and use of the Preferred Vendor program. Updated procedures of the Sole Source process. Additional language to clarify when staff must conduct a request for proposal and or a request for quotes process from new vendors. Updated procedures regarding formal communications to vendors on notice of award to vendors and vendor selection appeals process. Additional language regarding deliverables as well as business ethics and confidential information responsibilities of vendor selection teams to ensure fair vendor selection processes. New procedures and responsibilities for contract management (ie, amendments, termination, etc.) and vendor management. Updated to reference to the new Expense Policy and Travel Expense Policy.
The proposed changes have been fully reviewed and approved by L.A. Care’s Regulatory Affairs and Compliance and Legal Departments. 61 Board of Governors MOTION SUMMARY
Budget Impact: None
Motion: Approve the revisions of Procurement Policy (AFS-007) and the elimination of the Contract Review and Approval Process Policy (AFS-026).
Page 2 of 2 62
X X X X X X X X X X
-
of
02 t is 1
NO NO NO NO NO NO NO NO NO
NO NO 027) 026 63 20 2015 - - /
X AFS 007 AFS Page 32 Purchase Purchase
AFS
(AFS 01/10/ ##/## ##/##/2016
pertaining pertaining to YES YES YES YES YES YES YES YES YES YES YES
RAC Version Control #1B (10.30.2009)Control Version RAC
Dates
Applies to:
regulations
L.A. Care L.A. Plan
– – has established its own policies and and regulatory fees.
SEIU Plan SEIU - Cal Cal Cal - -
004) for procedures in acquiring non - Medicare SNP Medicare MediConnect Cal A. Care L. MediConnect Cal Plans Subcontracted Covered Care L.A. Policy and Procedure and Procedure Policy Number Pages No. of Total Date Effective Date Review/Revision Policy Supersedes Number PPSA/Mandated Review Next (Annual) Date Administrative Medi Partners Medi PASC Families Healthy Kids Healthy
to the state laws and legal legal retainer agreements, L.A. Care Health Plan (L.A. Care) FINANCE SERVICES ACCOUNTING : : Refer Refer to the Expense Policy (AFS
PROCUREMENT POLICY PROCUREMENT . bidding, bidding, L.A. L.A. Care will establish purchasing procedures and processes to develop
PROCUREMENT PROCUREMENT VENDOR VENDOR : procedures procedures relating to the purchase and procurement of products and services. I
: SERVICE AREA DEPARTMENT SERVICES TITLE POLICY SELECTION qualified qualified and reliable sources and to obtain quality and methods. procurement through competitive effective, efficient, prices reasonable products and services at fair and This policy excludes agreements, provider sponsorships, network contracts, Orders can employment be used as a method agreements, of keeping track of payments grant in cases like sponsorships grants and travel related meals and entertainment. Refer to the Travel Expense Policy on expenses. related travel procedures all for Although Although not generally competitive subject and L.A. Care’s policy to purchase products and services on the basis of quality, delivery, and price.
1.2 POLICY 1.1
1.0 1.0
Policy and Procedure Number 1501AFS-007 Page 2 of 32 While L.A. Care, organized as a health authority, is not bound by government (State or local) procurement Health Plan is generally not subject to the state laws and regulations. Nevertheless, L.A. Care desires to adopt this policy to establish a fair and equitable purchasing process which provides the organization with efficient, cost effective and pertaining to competitive purchasing methods. The bid requirements as statedbidding, it has established its own policies and procedures relating to the purchase and procurement of products and services. It is L.A. Care’s policy to purchase products and services on the basis of quality, delivery, and price. L.A. Care will establish purchasing procedures and processes to develop qualified and reliable sources and to obtain quality products and services at fair and reasonable prices through efficient, effective, and competitive procurement methods. The procedures in this policy may only be deviated from with the prior approval of both the Chief Executive Officer (CEO) and the Chief Financial Officer.
Products, services and capital assets in excess of established dollar amounts noted in this policy will be purchased using competitive bid procedures. The Purchasing (CFO), or their designees. The Procurement Department is primarily responsible foraligning procurement strategies with L.A. Care objectives; coordinating all bid preparations, communications and negotiations with contractors, vendors and suppliers involved in the provision of products, services and capital assets for L.A. Care. Bid processes (RFPs etc.) may be conducted and coordinated by other departments provided the Purchasing Department oversees the process to insure that purchasing policies and standards are adhered to during the processVendor Selection activity; and providing efficient procurement processes and tools. To ensure procurement strategies are aligned with L.A. Care objectives, a Procurement Council comprised of the Director of Procurement and L.A. Care Officers or designees will meet on a regular basis to develop, review, and refine procurement strategies and tactics on vendor consolidation opportunities, vendor management, contract management, and process improvement.
All requests for purchases must be reviewed and approved by the PurchasingProcurement Department prior to submitting the request for legal review and officerOfficer approval. All purchases of products, services and capital assets will only be made by authorized designated management personnel and according to approved authorization limits as defined in Policy AFS-006.
1.1 SCOPE
1.1.1 This policy covers the purchase of all products, services and capital assets required for the administration and operational functions of L.A. Care. 1.1.2 This policy does not include contracting with Plan Partners or the purchase of, or contracting with, healthcare providers involved in the actual delivery of healthcare services. Additional exclusions include grant agreements, sponsorships, employee benefits, utilities, insurance, business licenses, regulatory fees, and payroll services.
1.2 PURCHASING GUIDELINES
RAC Version Control #1B (10.30.2009) 64 Policy and Procedure Number 1501AFS-007 Page 3 of 32 1.2.1 Bid Methods and Parameters
1.2.1.1 Purchase Requisitions: Products, services (including professional and technical services) and capital assets with a total value less than $25,000 do not require a bid process and may be purchased using a standard Purchase Requisition and/or Check Request Form. Exception: When estimated annual purchases from one vendor exceed this dollar limit. 1.2.1.2 Request for Quotes (RFQ): The Request for Quotes purchase method will be used for the procurement of products and services defined as operating expenses and costing more than $25,000, but less than $250,000; and capital asset expenditures costing more than $25,000, but less than $100,000.
1.2.1.2.1 If an item is a standard product or service, a minimum of three written price and specification quotes are required. 1.2.1.2.1.1 For products of identical quality and specifications, the lowest price responsive bidder will be used. 1.2.1.2.1.2 For products or services which are not identical, but may vary by vendor, the award of a purchase contract will be given to a qualified responsive and responsible bidder whose bid conforms to the requirements and specifications of the RFQ, and who is determined the most appropriate for LA Care. 1.2.1.2.2 If an item is not a standard product or service, the selection of the vendor need not be solely based upon the lowest price if the vendor's experience, customer service, availability and range of products and services, references, etc. dictate that it would be more advantageous to L.A Care. 1.2.1.2.3 Documentation of purchase rationale is required stating the reasons for vendor selection and discussion of significant price differentials, if any exist. 1.2.1.2.4 A Request for Proposal must be used if the services or product requires more detail specifications and response. 1.2.1.2.5 A RFQ may be issued to a limited number of bidders who are known to be qualified.
1.2.1.3 Request for Proposals (RFP) The Request for Proposal purchase method shall be used for the procurement of capital assets and consulting services costing in excess of $100,000; and operating expenditures in excess of $250,000.
RAC Version Control #1B (10.30.2009) 65 Policy and Procedure Number 1501AFS-007 Page 4 of 32 1.2.1.3.1 The RFP method is a competitive negotiated purchase requiring a standard set of established purchase specifications, contract performance requirements, standard evaluation of RFP responses and an open competitive bid process. All RFP documents will include standard L.A Care requirements for vendor insurance coverage, performance bonds when applicable, appropriate state or local licenses and other requirements as deemed appropriate by L.A Care. 1.2.1.3.2 Evaluation of RFP responses will be based upon a predetermined set of evaluation criteria, which will be applied to all responsive bidders. Responses submitted which are determined to be nonresponsive will not be evaluated. Board approval of recommended contractors may be required in accordance with the Authorization Limits as established byand Approval Limit Policy AFS-006., as that policy may be amended from time to time.
This policy excludes provider network contracts, employment agreements, grant agreements, sponsorships, and regulatory fees. Purchase Orders can be used as a method of keeping track of payments in cases like grants and sponsorships.
1.2.1.3.3 DEFINITIONS:The RFP method should be used when the selection of a vendor can be made based on the following circumstances and criteria: 2.0 The total
Whenever a word or term appears capitalized in this Policy and Procedure, the reader should refer to the “Definitions” below.
2.1 Best Interest: This is aA discretionary rationale used by the Director of Procurement or his/ or her designee in taking action most advantageous to L.A. Care when it is impossible to adequately delineate other guidance through laws, regulations, or policies in L.A. Care’s best interest to consider award based on factors other than the lowest price for the products or services..
2.2 Bidder: A potential vendor who submits a response to an RFI, RFP, or RFQ.
1.2.1.3.3.1 Category: Commodity or category of purchase price (including tax and freight and installation) of products, capital assets, or services purchased exceeds the aforementioned limits above. 1.2.1.3.3.2 A complete purchase description and product specification is available. 1.2.1.3.3.3 The purchase is for a standard product or service, capital or fixed assets.
RAC Version Control #1B (10.30.2009) 66 Policy and Procedure Number 1501AFS-007 Page 5 of 32 1.2.1.3.3.4 There are at least two responsible bidders who can conform to and are willing to meet the bid requirements, product or services specifications. 1.2.1.3.3.5 The vendor selection can be made on the basis of price or a fixed fee contract. 1.2.1.3.4 For products or services which are not identical, but may vary by contractor, the award of a contract will be given to a qualified responsive and responsible bidder whose bid conforms to the requirements and specifications of the Request for Proposal and who is determined most appropriate for L.Asuch as Care. A bidder is deemed to be responsive and responsible when: 1.2.1.3.4.1 A responsive bidder is one whose bid meets the specifications set forth in the RFP. 1.2.1.3.4.2 A responsible bidder is one who has the resources, experience, expertise, service and financial capabilities to complete, in a timely manner, the requirements as specified in the RFP. 1.2.1.3.4.3 Contract awards will be made to the lowest priced responsive and responsible bidder whose bid conforms to the terms and conditions of the RFP. Even though the RFP provides for the awarding of a contract to the lowest priced bidder, after the final bidder is selected, L.A Care may further negotiate the price and terms. 1.2.1.3.4.4 A RFP may be distributed to a limited number of potential contractors when the purchase requirements are highly specialized and it is reasonably known that a small number of firms or organizations are capable of responding. Examples would be auditing services, specialized consulting services, specialized health education services or projects, etc.
1.2.2 Preferred Vendors - Request for Qualifications
1.2.2.1 Preferred Vendor List 1.2.2.1.1 A "Preferred Vendor List" may be used for the purpose of establishing ongoing contractual relationships with "Sole Source" vendors as well as vendors and suppliers who provide products and services to support L.A Care's recurring business activities such as office supplies, temporary labor, mail house fulfillment, printing, etc. L.A Care may use multiple contractors to provide similar products or services at equivalent or similar pricing.
RAC Version Control #1B (10.30.2009) 67 Policy and Procedure Number 1501AFS-007 Page 6 of 32 1.2.2.1.2 The Request for Qualifications method essentially pre- qualifies a potential vendor and is based upon the RFP methodology requiring a standard set of established purchase specifications, contract performance requirements, and a standard evaluation of responses. 1.2.2.1.3 Preferred Vendors will be required to reapply for Preferred Vendor Status at least every three years.
1.2.2.2 Request for Qualifications (RFQ) 1.12.3 The RFQ method may be used for the purchase of capital assets, and other products,consulting, IT equipment and services, and the total purchased amount cannot exceed the amount incorporated within the annual operating budget approved by the Board of Governors, or facility services.
2.4 Contract: Contract is aAn agreement between two parties such as L.A. Care and a Vendor that is enforceable by law, where one party offers a product or service while the other party accepts the product or service and provides payment. Examples of contracts are documents such as Purchase Orders, Purchase Agreements, and Services Agreements – all of which include a description of the product or services, the delivery terms and compensation, as well as terms and conditions. Master Agreements without a description of the product or services, the delivery terms and compensation, as well as other agreements such as Lletters of Iintent, Mmemoranda of Uunderstanding, while agreements, are not contracts in that they may not be enforceable by law.
2.5 Master Purchase Agreement (MPA): MPA is a framework document that contains legal terms and conditions to purchase products or services over a specific period of time, and generally includes a price list for offered products or services. Once an order for products or services is issued, the MPA and order, together, comprise a Contract. MPAs are used for recurring purchases.
2.6 Master Services Agreement (MSA): MSA is aA framework document that contains legal terms and conditions to purchase services over a specific period of time. On its own an MSA does not describe any services to be delivered. Typically, it is accompanied with a Schedule that describes the services to be provided, the deliverables, a delivery schedule and pricing. MSAs are used when it is anticipated that there will be multiple requirements for a particular vVendor.
Purchase Order/Purchase Agreement: A simplified Contract that contains standard terms and conditions and a description, pricing, and remittance information used to purchase a product or service from a vendor. It is issued and sent to a vendor typically after a Purchase Requisition has been fully approved.
Purchase Requisition: An internal document that contains the description, pricing, and total dollar amount of a purchase and that is routed through management for approval based on the dollar amount. After all approvals a Purchase Order is issued and sent to a vendor.
RAC Version Control #1B (10.30.2009) 68 Policy and Procedure Number 1501AFS-007 Page 7 of 32 2.7 Preferred Vendors: Vendors selected based on a competitive bidding process to provide products or services to support frequent or recurring requirements for a specified period of time pursuant to the terms of an MPA or MSA. Based on the terms of the MPA or MSA and the dollar value of a specific requirement, further competition may be required.
2.8 Preferred Vendor Listing: Listing of Preferred Vendors located at Pprocurement Iintranet that contains the Category of a purchase; name of the Preferred Vendor; and directions on how to purchase. It is meant for frequent and recurring purchases.
1.2.2.2.1 Procurement Council: Formal group comprised of the Director of Procurement and L.A. Care Officers or designees charged to align procurement strategies with the goals and objectives of L.A. Care. Evaluation of responses will be based upon a predetermined set of evaluation criteria, which will be applied to all responsive bidders. Responses submitted determined to be non-responsive will not be evaluated. 1.2.2.2.2 The Request for Qualifications method is used to identify firms capable of conforming to the requirements and specifications of the product or service and who are determined to be responsive and responsible contractors. 1.2.2.2.3 Qualified bidders will be notified that their responses establish the bidder as a "preferred vendor", and, if necessary, L.A Care may purchase goods or services from the contractor from time to time. Approval of a bidder as "preferred vendor" does not imply an award of a contract nor obligate L.A Care to purchase goods and services from the "preferred vendor". 1.2.3 Appeals to Purchase Decisions
1.2.3.1 Scope 1.2.3.1.1 Purchase determination conducted using the following bid methods may be appealed to L.A Care: 1.2.3.1.1.1 Request for Proposals 1.2.3.1.1.2 Request for Qualifications
1.2.3.2 Appeal Guidelines 2.9 All The group will meet on a regular basis to develop, review, and refine procurement strategies and tactics on vendor consolidation opportunities, vendor management, contract management, and process improvement.
2.10 Protected Health Information (PHI): Individually identifiable health information (essentially member information) that is transmitted and maintained in any form or medium. PHI excludes individually identifiable health information in education records covered by the Family Educational Rights and Privacy Act (FERPA), employment records held by L.A. Care in its role as employer, and such information regarding a person who has been deceased for more than fifty (50) years.
RAC Version Control #1B (10.30.2009) 69 Policy and Procedure Number 1501AFS-007 Page 8 of 32 2.11 Purchase Order/Purchase Agreement: A simplified Contract that contains standard terms and conditions and a description, pricing, and remittance information used to purchase a product or service from a vendor. It is issued and sent to a vVendor typically after a Purchase Requisition has been fully approved.
2.12 Purchase Requisition: An internal document that contains the description, pricing, and total dollar amount of a purchase and that is routed through management for approval based on the dollar amount. After all approvals a Purchase Order is issued and sent to a vendor.
2.13 Request for Information (RFI): An informal process for obtaining additional information relative to a product or service that is needed as part of L.A. Care’s market research. This helps L.A. Care identify potential sources or gain a better understanding of what products or services may be available.
2.14 Request for Proposal (RFP): A formal competitive bidding process to select a Vendor(s) from a pool of vendors who provide or produce the same or similar products or services. An RFP will have a set of requirements or specifications of what is needed and directions for the qualified vendors on how and when to submit their proposals. For this policy, it is typically reserved for high dollar (greater than $250,000) and more complex purchases that require time and resources.
2.15 Request for Quote (RFQ): An informal competitive bidding process based on price to select a vVendor(s) from a pool of vendors who provide or produce the same or similar product or service. An RFQ is typically used for lower dollar (less than $250,000 but greater than $25,000), less complex, and high transaction purchases. It can be used to get competitive pricing regardless of dollar amount when the competitive field is limited to Preferred Vendors in certain Categories like temporary labor and print.
2.16 Requestor: Designated person within a department who initiates purchase requests for either products or services.
2.17 Service Agreements: A Contract used for the one--time purchase of services.
2.18 Short List of VendorsBidders: A subset of the original pool of qualified vendorsBidders participating in an RFP who are finalists in a Vendor Selection process based on the evaluation criteria of the RFP.
2.19 Sole Source: An exception to the Vendor Selection process when only one Vendor is considered, in accordance with the process in Section 3.4outlined in this policy.
2.20 Statement of Work (SOW): Also known as a scope of work or scope of services, this is is the portion of a contract that describes the services to be delivered, the vendor’s responsibilities, L.A. Care’s responsibilities, timing, and costspricing.
RAC Version Control #1B (10.30.2009) 70 Policy and Procedure Number 1501AFS-007 Page 9 of 32 2.21 Vendor: A business entity, organization or individual who provides a product or a non- clinical service to the L.A. Care organization for payment.
2.22 Vendor Selection: A formal, value-based process by which a Vendor is selected from a pool of qualified vendors to perform services or deliver products to L.A. Care. Different Vendor selection techniques are used depending on complexity and dollar value of service or product in need. These techniques include RFPs, RFQs or RFIs.
Vendor Selection Team: A group of L.A. Care staff (may include consultants), led by the Director of Procurement or designee, and a team tailored for the particular purchase, that includes appropriate procurement, business, technical and other expertise who will review proposals to provide a comprehensive evaluation of offers and make reccommendations on the selection of vendors.
RAC Version Control #1B (10.30.2009) 71 Policy and Procedure Number 1501AFS-007 Page 10 of 32 3.0 PROCEDURES::
3.1 The procedures in this policy may only be deviated from with the prior approval of both the Chief Executive Officer (CEO) and the Chief Financial Officer (CFO), or their designees.
3.2 The Procurement department is primarily responsible for aligning procurement strategies with L.A. Care objectives, coordinating all Vendor Selection activity, and providing efficient procurement processes and tools.
3.3 To ensure procurement strategies are aligned with L.A. Care objectives, a Procurement Council comprised of the Director of Procurement and L.A. Care Officers or designees will meet on a regular basis to develop, review, and refine procurement strategies and tactics on vendor consolidation opportunities, vendor management, contract management, and process improvement.
3.4 All requests for purchases must be reviewed and approved by the Procurement department prior to submitting the request for legal review and Officer approval. All purchases of products, services and capital assets will only be made by authorized designated management personnel and in accordance with policy AFS-006, “Authorization and Approval Limit,” as that policy may be amended from time to time.
3.5 Refer to the Expense Policy (AFS-004) for procedures in acquiring non-travel related meals and entertainment. Refer to the Travel Expense Policy (AFS-027) for procedures on all travel related expenses.
The procedures in this policy may only be deviated from with the prior approval of both the Chief Executive Officer (CEO) and the Chief Financial Officer (CFO), or their designees. The Procurement department is primarily responsible for aligning procurement strategies with L.A. Care objectives; coordinating all Vendor Selection activity; and providing efficient procurement processes and tools. To ensure procurement strategies are aligned with L.A. Care objectives, a Procurement Council comprised of the Director of Procurement and L.A. Care Officers or designees will meet on a regular basis to develop, review, and refine procurement strategies and tactics on vendor consolidation opportunities, vendor management, contract management, and process improvement.
The procurement process for products and services is outlined in this policy. depicted below. TThe Requestor must use the process flowchart (attachment 6.1) diagram to determine which section applies to the business situation. The Procurement Ddepartment can assist the Requestor at any stage of the process.
RAC Version Control #1B (10.30.2009) 72 Policy and Procedure Number 1501AFS-007 Page 11 of 32
3.6
3.7 Business Requirements Definition:
3.7.1 Before any purchase, there are pre-requisite steps to understand what is being purchased.
3.7.2 The Requestor must first define what they are buying; a product, service, or both, and what Category the product/service fits into. For example, is it a product, service, or both and what Category does it fit into. Product examples include Categories likesuch as office supplies, IT equipment, promotional items, computer supplies, and print. Service examples include consulting (management or technical), temporary labor, facility services, construction services, mailing services, and assessment services. It is the responsibility of the business unit to adequately define its requirements, including product requirements or scope of work, delivery/schedule and pricing.
3.7.3 The Requestor canmay contact the Procurement Ddepartment for assistance in preparing product descriptions or SOWs; however, the ultimate responsibility is the business unit.
3.8 Review the Preferred Vendor List for Potential Sources:
3.8.1 Utilizing a Preferred Vendor for frequent or recurring purchases provides the following benefits:
RAC Version Control #1B (10.30.2009) 73 Policy and Procedure Number 1501AFS-007 Page 12 of 32 3.8.1.1 Greatly reduces organizational expenses by ensuring L.A. Care takes advantage of any discounts or reduced pricing that are already in a Preferred Vendors cContract. 3.8.1.2 Faster turnaround time because a vVendor and a cContract already exists and a new vVendor does not have to be selected and a new cContract does not need to be negotiated. 3.8.1.3 MinimizesReduces financial, operational, legal, information security, and privacy risks to L.A. Care because a Preferred Vendor is already under an legally approved cContract. 3.8.1.4 Saves L.A. Care resource costs associated with business administration, procurement processing and contracting, and legal review that are typically utilized when new cContracts are put in place. 3.8.2 The Requestor must check the latest Preferred Vendor Listing located at L.A. Care intranet site. The listing will contain the Category of products and services (i.e., office supplies, consulting, temporary labor, IT equipment, etc.), Preferred Vendor, and directions on how to purchase. In almost all cases, a Purchase Requisition and an executed Purchase Order will be required for each purchase. The Requestor can contact the Procurement Ddepartment for assistance.
3.8.2.1 If the product or service CAN be ordered from the Preferred Vendor Listing, then the Requestor must follow the directions outlined in the listing. In cases such as temporary labor, consulting, or print services, the Preferred Vendor Listing will outline when RFQs should be done to obtain competitive bids among a subset of Preferred Vendors within the same Category. If competition is required, the Requestor must follow §Section 3.17 below (6 RFQ Process). If the Preferred Vendor Listing outlines that a Contract is required, then the Requestor must follow §Section 3.187 below (Contracting Process). 3.8.2.2 If the product or service CANNOT be ordered from the Preferred Vendor Listing, then the Requestor must follow the procedures below.:
3.8.2.2.1 For purchases that are Sole Source, then the Requestor must follow §Section 3.48 below (, Sole Source Justification Process). Sole Source purchases are the exception and should only be used when authorized. Depending on the dollar limit, pursuant to §Section 3.8 below4.3, Sole Source purchases are reported up to the Board of Governors. 3.8.2.2.2 For purchases greater than $250,000, refer to go to Section §3.95 below (Vendor Selection Process). 3.8.2.2.3 For purchases greater than $25,000 up to $250,000, refer to §3.17 below (RFQ Process).
RAC Version Control #1B (10.30.2009) 74 Policy and Procedure Number 1501AFS-007 Page 13 of 32 3.8.2.2.4 For purchases up to $25,000, submit a Purchase Requisition to Procurement department and refer to §3.18 (Contracting Process) to see if a Contract is required.
3.9 Sole Source Purchasing Justification Process
3.9.1 Sole Source procurements may only be utilized in the circumstances and subject to the procedures set forth below.
For purchases greater than $25,000 up to $250,000, go to Section 3.6 RFQ Process
For purchases up to $25,000, submit a Purchase Requisition to Procurement Department and go to Section 3.7 Contracting Process to see if a Contract is required. Sole Source Purchasing Justification Process: Sole Source procurements may only be utilized in the circumstances and subject to the procedures set forth below. Only viable source for product or service, performance, and price competition are not available. 3.9.1.1 Only viable source for product or service, performance, and price competition are not available. 3.9.1.2 Only viable source possessing specialized or unique expertise. 3.9.1.3 Proposals were solicited, however no satisfactory proposals were received or only one satisfactory proposal was received. 3.9.1.4 Additional services are required to complete an ongoing task. It would be prohibitively costly in time and money to seek a new service provider. 3.9.1.5 Maintenance Service Agreements for equipment which must be serviced by the authorized manufacturer service representatives, and there is only one authorized service representative in the geographical area. 3.9.1.6 It is in the Best Interest of LA Care, e.g., administrative cost savings outweigh cost savings that would be realized through competition, steep learning curve for new service provider, knowledge base, etc. 3.9.1.7 It is more cost effective to obtain services by exercising an option under the existing contract. 3.9.1.8 Items requested are based upon previous purchases from this vVendor and are needed to match the existing product. 3.9.1.9 The requirement is within the general scope of an existing Contract and can be addressed appropriately as an amendment. 3.9.1.10 Emergency circumstances when a product or service is necessary and the time necessary to follow the required procurement process is not available.
3.9.2 Sole Source purchases must be justified before the actual purchase in sufficient detail using the Sole Source Justification form (attachment 6.3See Attachment A) to explain the basis for suspending L.A. Care’s usual Vendor Selection process and receive the required approvals as set forth in this policy. The Sole
RAC Version Control #1B (10.30.2009) 75 Policy and Procedure Number 1501AFS-007 Page 14 of 32 Source Justification must be submitted as part of the Purchase Requisition or Board motion package if a motion is required. 3.9.3 Any proposed Sole Source purchase greater than $25,000 and up to $250,000 must be approved by a Director or Officer level and the Manager of Procurement. Sole Source purchases over $250,000 must be approved by Director of Procurement, Officer, CFO, and CEO or designee as well as be reported to the Board of Governors or its Board Committee designee on a quarterly basis.
3.9.4 Emergency Purchases:
3.9.4.1 The CEO or designee may authorize Sole Source purchases in cases that have or could impose significant provable loss to L.A. Care; short turn-around time mandated by regulatory agencies, contractual requirements, or changes in the law; or where human life or property is endangered. When an emergency condition arises and the need cannot be met through normal procurement methods, the emergency purchase shall be made with such competition as is feasible under the circumstances, including soliciting quotes orally. Contracts and other documents related to such emergency procurements shall be executed in accordance with the requirements of policy AFS-006, “the Authorization and Approval Limit.” Policy (AFS-006). Within a reasonable time after the conclusion of the emergency, the Officer responsible for the emergency purchase shall provide written documentation stating the basis for the emergency purchase and the reasoning for the selection of the particular vVendor. A written account of the emergency circumstances shall be sent promptly to the CEO or designee. Normal purchasing procedures shall be followed as soon as the emergency is over.
3.10 Vendor Selection Process (Purchases > $250,000):
3.10.1 Prior to starting the Vendor Selection Process, the Requestor should have already checked the Preferred Vendor Listing per Section 3.3 and determined if Sole Source is necessary per Section3.4.
3.10.2 If the Requestor’s purchase cannot be fulfilled by a Preferred Vendor and is not a Sole Source, the Requestor must contact the Procurement Ddepartment to initiate the Vendor Selection Process. The Vendor Selection Process, also known as Strategic Sourcing, is utilized for purchases greater than $250,000 under this policy.
3.10.3 The Vendor Selection Process consists of the steps outlined in attachment 6.2 and deliverables developed by both procurement and a Vendor Selection team made up of the Requestor and other L.A. Care staff participating in the process.
RAC Version Control #1B (10.30.2009) 76 Policy and Procedure Number 1501AFS-007 Page 15 of 32 3.10.3.1 All deliverables (identified in attachment 6.2) are required where they are applicable. Please refer to attachment 6.2, which includes the steps for the Vendor Selection Pprocess as well as a flowchart depicting the overall process. The diagram below depicts the overall process. The process consists of the following steps and deliverables developed by both procurement and a Vendor Selection team made up of the Requestor and other L.A. Care staff participating in the process. The deliverables below are all required where they are applicable.
3.10.3.2 Please refer to attachment 6.2, which includes the steps for the Vendor Selection process as well as a flowchart depicting the overall process.
3.10.3.3 After the Vendor Selection Process is complete in most cases, a Contract will be required. See Section §3.18 Contracting Process.
3.10.3.4
3.11 General RFP Contents:
3.11.1 The most current RFP template will be maintained by Procurement Ddepartment and tailored to fit the business need. An RFP shall include, but not be limited to the following:
3.11.1.1 Instructions to vendors 3.11.1.2 Objectives of RFP
RAC Version Control #1B (10.30.2009) 77 Policy and Procedure Number 1501AFS-007 Page 16 of 32 3.11.1.3 RFP schedule 3.11.1.4 Business and technical requirements 3.11.1.5 Pricing or total cost of operation (TCO) model template 3.11.1.6 Contract performance requirements, performance standards and guarantees, price adjustments 3.11.1.7 Latest applicable Contract templates (MSA, MPA, Service Agreement, etc.) 3.11.1.8 Evaluation criteria 3.11.1.9 Ability to cancel RFP or reject all proposals.
3.12 Evaluation Criteria:
3.12.1 The selection of the successful Vendor will be based upon evaluation by L.A. Care in accordance with the RFP criteria considering all appropriate factors and criteria (subjective and otherwiseobjective) as L.A. Care may, at its sole discretion, deem relevant and in the Best Interest of L.A. Care. In no event will L.A. Care be limited to selecting a successful bidder based solely upon the lowest price proposed.
3.12.2 Vendors’ responses to an RFP will be evaluated on the following factors stated in the RFP, including, but not limited to:
3.12.2.1 Ability to meet business and technical requirements 3.12.2.2 Ability to provide a clear approach to meet SOW requirements 3.12.2.3 Ability to provide a comprehensive quality control plan 3.12.2.4 Qualifications and experience 3.12.2.5 Site visit, presentation, and/or demonstrations 3.12.2.6 Price or TCO 3.12.2.7 Willingness to accept L.A. Care’s contractual terms and conditions
3.13 Bidders’ Conference
3.13.1 : L.A. Care may conduct a bidders’ conference as it deems necessary and appropriate. In such cases, L.A. Care shall include the date, time, and location in the RFP documents. The Vendor Selection Team and the Procurement Ddepartment will jointly be responsible for organizing and conducting the bidders’ conference.
3.14 Point of Contact; Notice of Award
3.14.1 : The Procurement Ddepartment resource working on the RFP will serve as the single point of contact during a Vendor Selection process. After the Vendor Selection Team evaluates vendorbidders’ proposals, the Procurement Ddepartment resource will formally communicate to the vendorbidders alongduring the process. VendorsBidders will be notified if they have or have not made the Short List of VendorsBidders (if applicable) and if they have or have not made the final award. For vendorsBidders who did not make the final
RAC Version Control #1B (10.30.2009) 78 Policy and Procedure Number 1501AFS-007 Page 17 of 32 selection, the Procurement Ddepartment resource canmay discuss if necessary what requirements of the RFP the vendorsBidders did not meet in L.A. Care’s Best Interests.
3.15 Vendor Selection Appeals Process
3.15.1 All appeals of a Vendor Selection must be received in writing no later than 10 business days following the announcementformal communication via email to all vendors who participated in the Vendor Selection process. of the purchase award of Contract. Appeals must be addressed and delivered to L.A. Care, attention to the Chief Financial Officer or designee. Only appeals that are based on procedural issues will be considered for review. Procedural issues subject to review may include the following: incomplete or erroneous scoring; bid responses were not fully reviewed; other procedural errors or omissions. The bidder must demonstrate that the claimed error (basis for the appeal) was prejudicial to the bidder, i.e., that but for the error, the bidder would have been selected for award.
3.15.2 All appeal decisions made by L.A. Care will be communicated in writing to the appealing party within 20 business days of receipt of the appeal. All appeal decisions made by L.A. Care are final.
3.16 Disclosure of Proposals and L.A. Care’s Evaluation of Proposals
1.2 Vendor Selection Appeals Process: All appeals of purchase determinationsa Vendor Selection must be received in writing no later than ten (10) business days following the announcement of the purchase award of contract.
1.2.3.2.1 Contract. Appeals must be addressed and delivered to L.A. Care, attention to the Chief Financial Officer. 1.2.3.2.2 or designee. Only appeals that are based on procedural issues will be considered for review. Objective evaluation criteria as established by LA Care will not be eligible for appeal. Procedural issues subject to review wouldmay include but would not be limited to the following: 1.2.3.2.2.1 Incomplete incomplete or erroneous scoring. Bid; bid responses were not fully reviewed.; other 1.2.3.2.2.2 Other procedural errors or omissions. 1.2.1 All appeal decisions made by L.A. Care will be communicated in writing to the appealing party within twenty (20) business days of receipt of the appeal. All appeal decisions made by L.A. Care are final.
1.2.3.2.3 All appeal decisions made by LA Care will be final.
RAC Version Control #1B (10.30.2009) 79 Policy and Procedure Number 1501AFS-007 Page 18 of 32 3.16.1 Disclosure of Proposals and L.A. Care’s Evaluation of Proposals. Generally, Vendors’Bidders’ proposals and L.A. Care’s evaluation of the proposals, including the basis for selection, are considered to be confidential information and should not be shared outside the Vendor Selection Team. If a request for copies of either a Vendor’sBidder’s proposal or the evaluation is received, whether orally or in writing, the request must be treated as a request for records under the California Public Records Act (PRA). All such requests must be referred to the Legal Services Ddepartment immediately in order to respond to the request in the times mandated by the PRA.
3.17 Code of Conduct:
3.17.1 L.A. Care staff and consultants participating in the Kick-Off & Vendor Selection Assess Process shall conduct themselves in such a manner as Opportunities/ to foster public confidence in Determine the integrity Goals of L.A. Care’s Develop Contract Market Vendor Management Research Profile Selection process. L.A. Care staff shall
Develop Complete Sourcing Contract(s) Strategy
perform their duties impartially to ensure Negotiate and Exectue Sou that Select VendorsBidders have fair Vendor(s) rcing Strategy and competitive access to do business with L.A. Care. Employees and consultants are subject to applicable state conflict of interests laws and regulations, as well as internal requirements, including obligations of confidentiality and the use of confidential information, as prescribed by L.A. Care’s Code of Conduct, the Vendor Code of Conduct and the consultant’s Contract with L.A. Care. No L.A. Care employee or consultant shall solicit,
RAC Version Control #1B (10.30.2009) 80 Policy and Procedure Number 1501AFS-007 Page 19 of 32 demand, or accept from any person anything of monetary value for, or because of, any action taken, or to be taken in the performance of his/her duties. Any employee or consultant failing to adhere to the above shall be subject to any disciplinary proceeding deemed appropriate by L.A. Care, including and up to termination of employment or the consultant’s Contract.
3.18 Request for Quote Process (Purchases between $25,000 and $250,000 or as defined in Preferred Vendor Listing).
3.18.1 RFQs help L.A. Care purchase products or services at fair and reasonable prices. Prior to starting the RFQ Process, the Requestor should have already checked the Preferred Vendor Listing per Section 3.2 and determined if Sole Source is necessary per Section 3.4. If the Requestor’s purchase cannot be fulfilled by a Preferred Vendor and is not a Sole Source, then Requestor must follow the steps below. If there is a business need for a competitive bid process beyond just pricing for a purchase below $250,000, the Procurement Ddepartment will use its discretion to direct the Requestor to the Vendor Selection Process in §Section 3.95.
3.18.2 The Requestor obtains at least three quotes from vendorsbidders that provide similar product or service within a Category and selects the vendor based on price and delivery. Procurement director or manager will use discretion if less than three quotes is allowable.
3.18.3 The Requestor submits a Purchase Requisition and all quotes received to the Procurement Ddepartment.
3.18.4 A Procurement Ddepartment resource will help the Requestor to determine the type of Contract needed. The Requestor must follow Section §3.187 (Contracting Process) to finish the purchase.
3.18.5 The Requestor will route any approvals in accordance with policy AFS-006, “ to the Authorization and Approval Limit. ”Policy (AFS-006).
3.18.6 The Procurement Ddepartment will issue a Purchase Order and send to the Vvendor after the approvals have been complete.
3.19 Contracting Process:
3.19.1 Contracts are required and must be reviewed by the Procurement Ddepartment and Legal Services Ddepartment if ANY of the conditions are true:
3.19.1.1 Purchase greater than $10,000. 3.19.1.2 Purchase requires PHI exchanged with the Vendor. 3.19.1.3 The Vendor's performance may subject L.A. Care to liability that would be disproportionate to the value of the vVendor's services.
RAC Version Control #1B (10.30.2009) 81 Policy and Procedure Number 1501AFS-007 Page 20 of 32 3.19.2 If the conditions above are not true, then the Requestor should submit a Purchase Requisition to the Procurement Ddepartment.
3.19.3 If there is a legitimate, critical business need for an expedited process, the Requestor must contact the Procurement department. This is for exceptions only and is not a substitute for a lack of planning by the Requestor or Requestor’s department. Approvals from CEO and/or CFO maybe required.
3.19.4 New Contracts
: The Requestor must submit the Purchase Requisition through the Procurement Ddepartment’s procurement or contracting system and attach any pertinent information, such as applicable quotes, contract documents, Sole Source Justification, Board motions, cover memos, etc. The following steps and approvals are required. The Procurement Ddepartment can assist the Requestor on any of the following steps.
3.19.4.1
The Requestor must acquire Contract templates from the Procurement Ddepartment who will help ensure the latest L.A. Care legally approved Contract templates are properly used for the purchase, including whether or not an MSAmaster or one-time or Service Agreement is to be used.
3.19.4.2
The Requestor must draft business requirements of the needs of the Officer or designee that to captureinclude, at a minimum, a complete and clear description of services or product; expected responsibilities of the vVendor and L.A. Care; any deliverables; service levels; length of service/required delivery dates; purchase amount; and payment process. This is typically a collaborative, iterative review process between the Requestor, vVendor, and the Procurement Ddepartment if necessary iin order to get to a final draft.
3.19.4.3
3.19.4.4 The Requestor must check the Vendor against the debarred and exclusion listings maintained by L.A. Care’s Compliance Officerthe U.S. General Services Administration and the Office of the Inspector General, US Department of Health & Human Services. Procurement must approve all vendor setup and/or changes on vendor maintenance file or record for appropriate control checks such as tax identification numbers before formal setup and/or changes are made into L.A. Care procurement, contract, or financial system. Exceptions to approvals may apply to vendor setups such as for member refunds.
RAC Version Control #1B (10.30.2009) 82 Policy and Procedure Number 1501AFS-007 Page 21 of 32
3.19.4.5
The Requestor must prepare the Sole Source Justification and obtain approval, if applicable per Section 3.4.
3.19.4.6
The Requestor must acquireobtain the Privacy and Information Security Officer’s approval to identifyof any privacy or information security and PHI concerns so that to those appropriate terms are incorporated in the AgreementContract.
3.19.4.7
The Requestor must acquire IT approval to ensure IT-related purchases such as software, hardware, cloud services, etc., meet IT standards and are compatible with L.A. Care systems.
3.19.4.8
The Requestor must obtain approval from both Procurement and the Legal Services Ddepartment for negotiation of terms, pricing, vendor performance standards or warranties, indemnity, and insurance requirements are finalized in the Contract.
3.19.4.9
The Requestor must acquireobtain all approvals based on dollar amount in accordance with policy AFS-006, “to the AAuthorization and Approval Limit, Policy” (AFS-006) including filingsubmitting any motions required for any Finance & Budget Committees or Board of Governors approvals.
3.19.4.10 After all approvals above, the Requestor or Procurement must copiesacquire L.A. Care signatures in accordance with policy AFS- 006 and Vendor signatures of the final Contract. Electronic signatures are permitted.
3.19.4.11 When the final Contract is fully signed, the Requestor must send one original or electronic copy to the vVendor, the second original or electronic copy to L.A. Care Legal Services Ddepartment, and an electronic copy to the Procurement Ddepartment.
RAC Version Control #1B (10.30.2009) 83 Policy and Procedure Number 1501AFS-007 Page 22 of 32 3.19.4.12 The Procurement department will issue a Purchase Order and send to the Vendor after the approvals have been complete.
3.19.5 Changes to Unexpired Contracts
3.19.5.1 : If an existing and still active Contract is already in place and needs to be changed or amended to extend the term of the Contract, increase scope, change pricing, or change any Contract provision, then the Requestor must contact the Procurement Ddepartment to initiate an amendment against the Contract and then follow §Section 3.18 (Contracting Process)7.1.
3.20 Contract Management
3.20.1 : Once a new Contract is in place, the rebusiness owner and the Procurement department have are ongoing responsibilities to ensure the vVendor is fulfilling its obligations under the Contract. Contractual terms such as fee adjustments, service levels, performance guarantees, termination rights, etc., can be unique on each contract. Therefore, the Procurement Ddepartment, the business owner of the Contract, and the Legal Services Ddepartment (if necessary) will collaborate to determine the appropriate action and communication to a vVendor who is not fulfilling the contractual obligations. The Procurement Ddepartment will maintain a Contract repository of all vendor Contracts and manage expirations by notifying the L.A. Care business owners of the Contracts at least 90 days before they expire (unless a longer period of time is required by the Contract) in order to determine if the contract should be renewed or allowed to expire, or if an RFP needs to be completed. In addition, the Procurement Ddepartment will analyze all Contract expirations and develop strategies that include vendor and/or contract consolidation opportunities.
3.20.2 Procurement Responsibilities:
3.20.2.1 Monitors vendor contract expirations. 3.20.2.2 Notifies business owner or designee of upcoming expirations at least 90 days prior to Contract expiration. 3.20.2.3 Reviews and analyzes contract expirations for vendor and/or contract consolidation opportunities. 3.20.2.4 Monitors vendor compliance to pricing terms. 3.20.2.5 Co-develop a Vendor Mmanagement scorecard of key metrics and key performance indicators (KPIs) if necessary. 3.20.2.6 Participates and collaborates with vVendor in developing vendor continuous improvement programs and corrective action plans if necessary. 3.20.2.7 Recommends and develops any contractual amendments with L.A. Care’s Legal Services department.
3.20.3 Business Owner or Designee Responsibilities:
RAC Version Control #1B (10.30.2009) 84 Policy and Procedure Number 1501AFS-007 Page 23 of 32
3.20.3.1 Monitors vendor compliance to performance terms and deliverables. 3.20.3.2 Co-develop a Vendor Mmanagement scorecard of key metrics and KPIs if necessary. 3.20.3.3 Participates and collaborates with vendor in developing vendor continuous improvement programs and corrective action plans if necessary. 3.20.3.4 Works with the Privacy Officer in the return or destruction of PHI if necessary.
Procurement Responsibilities Business Owner or Designee Responsibilities Monitors vendor contract expirations. Monitors vendor compliance to Notifies business owner or designee of performance terms and deliverables. upcoming expirations at least 90 days Co-develop a Vendor Management prior to Contract expiration. scorecard of key metrics and KPIs if Reviews and analyzes Contract necessary. expirations for vendor and/or contract Participates and collaborates with consolidation opportunities. vendor in developing vendor Monitors vendor compliance to pricing continuous improvement programs terms. and corrective action plans if Co-develop a Vendor Management necessary. scorecard of key metrics and KPIs if Works with Privacy Office in the necessary. return or destruction of PHI if Participates and collaborates with vendor necessary per Section 3.10. in developing vendor continuous improvement programs and corrective action plans if necessary. Recommends and develops any contractual amendments with L.A. Care legal.
3.21 Termination of Contracts:
3.21.1 Expiring Contracts
3.21.1.1 : The Procurement Ddepartment will notify the business owner at least 90 days prior to Contract expiration. If the business owner does not respond after multiple documented attempts, including escalation to an Officer, then the Contract will be assumed completed. The Procurement Ddepartment will assist with Contract close out requirements, but the Requestor and business owner will be ultimately responsible for notifying the Privacy and Information Security Officer if PHI needs to be formally returned to L.A. Care or destroyed.
RAC Version Control #1B (10.30.2009) 85 Policy and Procedure Number 1501AFS-007 Page 24 of 32
3.21.2 Terminating Contracts prior to Expiration
3.21.2.1 : If a Contract needs to be terminated prior to the Contract expiration, the Requestor must contact the Procurement Ddepartment. The Procurement Ddepartment will assist the Requestor in coordinating the termination with L.A. Care Legal Services Ddepartment. Once the Contract is terminated, the Procurement Ddepartment will assist with Contract close out requirements, but the Requestor and business owner will be ultimately responsible for notifying the Privacy and Information Security Officer if PHI needs to be formally returned to L.A. Care or destroyed. 3.21.2.2 If a Contract needs to be terminated prior to the Contract expiration for vendor issues such as non-performance or undelivered products and/or services, then the Requestor must contact Procurement Department who will coordinate with L.A. Care Legal Services Department for either a termination for breach of Contract or opportunity to cure vendor issues.
3.22 Vendor Management
3.22.1 : Vendor Mmanagement is applicable and typically reserved for those Vendors that are of high impact to L.A. Care in terms of dollars paid to the vVendor and of high impact to L.A. Care operations in serving its members. The intent is to properly manage the vVendor relationship to manage and mitigate risks and ensure the strategic goals and objectives of L.A. Care are being met. Vendor Mmanagement includes all the responsibilities of Contract Management Section 3.9 along with the following:
Agreed upon service levels and/or performance guarantees defined and incorporated in a fully executed Contract between L.A. Care and the vendor.. 3.22.1.1 3.22.1.2 A formal governance structure defined and incorporated in a fully executed Contract between L.A. Care and the vendor.
3.22.1.3 A formal scorecard to measure the contractual service levels, performance guarantees, and program/project milestones.
3.22.1.4 Formal, recurring review meetings outlined in the governance structure from Section 3.11.2 between the Officer or designee level and the vendor’s executive leadership, when the complexity and scope of the Contract warrants. At a minimum, the meeting agenda should include:
RAC Version Control #1B (10.30.2009) 86 Policy and Procedure Number 1501AFS-007 Page 25 of 32 3.22.1.4.1 Review of the vendor scorecard from Section 3.11.3.
3.22.1.4.2 Develop and follow-up on corrective action plans for both L.A. Care and the vendor to resolve any strategic or tactical issues.
3.22.1.4.3 Develop any new innovative strategies and tactics that continuously improve the value and performance of the relationship to achieve L.A Care’s goals and objectives.
4.0 AUTHORITY:
None
5.0 REFERENCES:
5.1 Policy AFS-004, “Expense Policy” 5.2 Policy AFS-006, “Authorization and Approval Limit” 5.3 Policy AFS-027, “Travel Expense Policy”
6.0 ATTACHMENTS:
6.1 Process Flowchart 6.2 Vendor Process Selection Steps & Flowchart 6.3 Sole Source Justification Form
ACCOUNTABILITY MATRIX Responsible Department(s) Policy Section #
ELECTRONICALLY APPROVED BY THE FOLLOWING Regulatory Affairs & Officer Director Compliance Name Tim Reilly Patricia Mowlavi Denise Corley Executive Services Accounting Services Regulatory Affairs & Department Compliance Title Chief Financial Officer Senior Director Compliance Officer IF APPLICABLE
RAC Version Control #1B (10.30.2009) 87 Policy and Procedure Number 1501AFS-007 Page 26 of 32
Board of Governors Motion Number:
*Note: Please write “N/A” for the Name, Department, and Title of the Director if this approval is not applicable.
POLICY HISTORY Policy or Next or Annual Date Department Comment(s) Section # Review Date 01/10/02 Accounting & AFS-007 New Policy 01/10/03 Financial Services 02/10/10 Accounting Services AFS-007 Capital Assets defined as items 02/10/11 with value greater than $2,000 ##/##/15 Accounting Services AFS-007 Annual Review; major changes. ##/##/16
2.0 DEFINITIONS:
2.1 Products and Services: Products and services include any department supplies, products, services and equipment used for administrative and operational purposes.
2.2 Capital Assets Furniture, Equipment and Leasehold Improvements: Capital Assets are defined as any tangible property item with a value in excess of $2,000 including tax, installation and freight and a useful life expectancy of one or more years.
2.3 Request For Proposal (RFP): The RFP method is an open competitive bid process that is formalized by requiring a standard set of established specifications, contract performance and evaluation process.
2.4 Request For Quotes (RFQ): The RFQ method is a less formal competitive bid process than the RFP method, usually consisting of written price comparisons from vendors.
2.5 Contracts: Contracts are binding written agreements between L.A Care and an independent party or vendor for the supply of goods and/or services at a mutually agreed price. All contracts must be reviewed by L.A Care's Financial Services and Legal Services Departments prior to execution, per Policy AFS-006, Section 1.1.3.
2.6 Preferred Vendor: Vendors and suppliers who provide products and services to support L.A Care's recurring business activities such as office supplies, temporary labor, mail house fulfillment, printing, etc.
RAC Version Control #1B (10.30.2009) 88 Policy and Procedure Number 1501AFS-007 Page 27 of 32 2.7 Sole Source Vendor: Vendors and suppliers who provide specific or "one of a kind" products and services, which are unique to L.A Care's business needs or equipment specifications, such as IT system maintenance and support, data base management systems, software licenses, legal services, etc.
3.0 PROCEDURE/S:
N/A
2.0 AUTHORITY: N/A
N/A
3.0 REFERENCE: N/A
N/A
RAC Version Control #1B (10.30.2009) 89 Policy and Procedure AFS-007 Page 28 of 32
Accountability Matrix Responsible Department(s) Policy Section #
2
90 Policy and Procedure AFS-007 Page 29 of 32
APPROVAL:
APPROVAL:
Regulatory Affairs & Compliance Date: Name: André G. AcostaDenise R. Corley, R.N. Title: Compliance Officer
Director Date: Name: Patricia Mowlavi Title: Senior Director, Accounting Services
Officer Date: Name: W. Randy StoneTim Reilly Title: Chief Financial Officer
IF APPLICABLE Board of Governors Date: Motion #:
Policy History Policy or Annual Date Department Section # Comment(s) Review 02/2010 Accounting Services 2.2 Capital Assets defined as items with value greater than $2,000
2
91 Policy and Procedure AFS-007 Page 30 of 32
Attachment A
Sole Source Justification
Vendor: ______
Contract Start/End Date: ______
Contract Amount: ______
Date:______
Identify applicable justification and provide documentation for each checked item.
Only viable source for product or service, performance and price competition are not available.
Only viable source possessing specialized or unique expertise.
Proposals were solicited, however no satisfactory proposals were received or only one satisfactory proposal was received.
Additional services are required to complete an ongoing task. It would be prohibitively costly in time and money to seek a new service provider.
2
92 Policy and Procedure AFS-007 Page 31 of 32
Maintenance Service Agreements for equipment which must be serviced by the authorized manufacturer service representatives, and there is only one authorized service representative in the geographical area.
It is in the Best Interest of LA Care, e.g., administrative cost savings outweigh cost savings that would be realized through competition, steep learning curve for new service provider, knowledge base, etc.
It is more cost effective to obtain services by exercising an option under the existing contract.
Items requested are based upon previous purchases from this vendor and are needed to match the existing product.
The requirement is within the scope of an existing Contract and can be addressed as an amendment.
RFP previously executed. Date: ______
Other, please explain:
______
Approvals for Purchases from $25,000 up to $250,000:
Director/Senior Director/Officer: ______
Manager of Procurement: ______
Approvals for Purchases greater than $250,000*:
Officer: ______
Director of Procurement: ______
CFO: ______
CEO: ______
2
93 Policy and Procedure AFS-007 Page 32 of 32
*Sole Source purchases greater than $250,000 will be reported to Board of Governors or its Board Committee designee on a monthly basis.
2
94 Attachment 6.1 (AFS-007)
95 Attachment 6.2 (AFS-007)
Key Tasks and Responsibilities Steps Procurement Resource Vendor Selection Team Key Deliverable 1 Kick-Off & Assess Collects and analyzes high Participates in the analysis of Project charter Opportunities/ level data the data and assessment of Determine Goals Assesses the opportunities opportunity Determine goals Identify team decision makers 2 Develop Category Determine: Reviews and validates List of potential vendors Profile (if applicable) What we buy deliverables (if applicable) Vendor spend history report (if Potential known vendors applicable) When we buy Current procurement and Estimated unit cost or fees and payment process (if applicable) expenses 3 Generate Market Identify industry leading Reviews and validates Market research report (i.e., Research Profile (if vendors deliverables (if applicable) Gartner, etc. if applicable) applicable) Determine vendors value- Additional potential vendors added capabilities Identify industry trends 4 Develop Sourcing Develops a sourcing strategy Develops a sourcing strategy Business and technical Strategy that utilizes a Total Cost of that utilizes a TCO model requirements including Ownership, (TCO) model Assess negotiation leverage functional, task, quality, and Assess negotiation leverage Evaluate alternative strategies service level requirements Evaluate alternative strategies TCO financial model Contract strategy Vendor Management strategy (if applicable) 5 Execute Sourcing Develops list of vendors Approves final list of vendors Final list of vendors for RFP Strategy Leads development of RFP Reviews and approves RFP RFP including evaluation criteria including evaluation criteria Vendor Proposals and weightings and weightings RFP Scoring Report Sends RFP to qualified, Participates in fielding vendor Short List of Vendors (if
96 Attachment 6.2 (AFS-007)
approved list of vendors questions during RFP process applicable) Serves as single point of Participates in Bidder’s Additional or secondary contact between vendors and Conference if necessary scoring report from Short List L.A. Care Scores vendor proposals of vendor presentations, site Manages and fields vendor Approves Short List of visits, and/or demos (if questions during RFP process Vendors applicable) Moderates Bidder’s Participates and scores Conference if necessary presentations, site visits, Applies RFP scoring and/or demos if necessary methodology Performs Reference Checks Issues any amendments to RFP Scores pricing component of vendor proposals using TCO model Develops Short List of Vendors from RFP scoring Develops secondary scoring for vendor presentations, site visits, and/or demos if necessary 6 Negotiate and Select Develops negotiation strategy Assists in negotiations as Final selection in the Best Vendor(s) Conducts negotiations necessary Interest of L.A. Care 7 Complete Contract Prepares the final Contract Reviews procurement and Signed Contract(s) with legal department payment process Final procurement and Develops procurement and Reviews final Contract payment process payment process Signs or acquires contract Executed Purchase Order Incorporates a vendor signatures in accordance with governance structure if AFS-006 and Sections 3.7.1.9 necessary and 3.7.1.10 Implements Vendor Implements technical and Management if necessary business oversight portions of
97 Attachment 6.2 (AFS-007)
Sends executed Purchase Order Vendor Management if to vendor necessary 8 Contract Management Monitors vendor compliance to Monitors vendor compliance On-going pricing terms. to performance terms and If necessary: Develops a Vendor deliverables. Vendor scorecard Management scorecard of key Develops a Vendor Vendor Correction Action metrics and key performance Management scorecard of key Plans indicators (KPIs) if necessary. metrics and KPIs if necessary. Contract Amendments Participates and collaborates Participates and collaborates Return or destruction of PHI with vendor in developing with vendor in developing vendor continuous vendor continuous improvement programs and improvement programs and corrective action plans if corrective action plans if necessary. necessary. Recommends and executes any Works with the Privacy and contractual amendments that Information Security Officer improve vendor performance. in the return or destruction of Monitors contract expirations. PHI if necessary. Performs Contract close-out activities (final invoices, release of claims, return of property or information, etc.)
98 Attachment 6.2 (AFS-007)
Kick-Off & Assess Opportunities/ Determine Goals
Contract Develop Management Category Profile
Complete Develop Market Contract(s) Research Profile
Develop Negotiate and Sourcing Select Vendor(s) Strategy
Exectue Sourcing Strategy
99 Attachment 6.3 (AFS-007)
Sole Source Justification
Vendor: ______
Contract Start/End Date: ______
Contract Amount: ______
Date:______
Identify applicable justification and provide documentation for each checked item.
Only viable source for product or service, performance and price competition are not available.
Only viable source possessing specialized or unique expertise.
Proposals were solicited, however no satisfactory proposals were received or only one satisfactory proposal was received.
Additional services are required to complete an ongoing task. It would be prohibitively costly in time and money to seek a new service provider.
Maintenance Service Agreements for equipment which must be serviced by the authorized manufacturer service representatives, and there is only one authorized service representative in the geographical area.
100 It is in the Best Interest of L.A. Care, e.g., administrative cost savings outweigh cost savings that would be realized through competition, steep learning curve for new service provider, knowledge base, etc.
It is more cost effective to obtain services by exercising an option under the existing contract.
Items requested are based upon previous purchases from this vendor and are needed to match the existing product.
The requirement is within the scope of an existing Contract and can be addressed as an amendment.
RFP previously executed. Date: ______
Other, please explain:
______
Approvals for Purchases from $25,000 up to $250,000:
Director/Senior Director/Officer: ______
Manager of Procurement: ______
Approvals for Purchases greater than $250,000*:
Officer: ______
Director of Procurement: ______
CFO: ______
CEO: ______
*Sole Source purchases greater than $250,000 will be reported to Board of Governors or its Board Committee designee on a quarterly basis.
101 Board of Governors Executive Community Advisory Committee
Meeting Minutes – March 11, 2015 L.A. Care Health Plan, 1055 West 7th Street, Los Angeles, CA 90017 ECAC Members RCAC Members/Public L.A. Care Board of Governors/Staff María Adela Guadarrama, RCAC 1 Chair, Russell Mahler, RCAC 1 Hilda Pérez, Consumer Member, Board of Governors Carlos Aguirre, RCAC 2 Chair Ana Rodriguez, RCAC 2 Ozzie López, Member Advocate, Board of Governors Lidia Parra, RCAC 3 Chair Cynthia Conteas-Wood, RCAC 3 John Wallace, Interim Chief Executive Officer Hercilia Salvatierra, RCAC 4 Chair María Argueta, RCAC 4 Maribel Ferrer, Senior Director, Member and Medi-Cal Operations Romalda Meza, RCAC 5 Chair Guadalupe Reynoso, RCAC 5 Clayton Chau, MD, Medical Director, Behavioral Health & Dove Savage Pinkney, RCAC 6 Chair Olivia Avalos, RCAC 6 Provider Continuing Education Departments. Dalia Cadena, RCAC 7 Chair Fátima Vázquez, RCAC 7 Diana Amaya, Member Retention Unit, Member Services Department Ana Romo, RCAC 8 Chair, ECAC Vice Chair Samouth Von, RCAC 9 Idalia Chitica, Community Outreach Lead Field Specialist CO&E Cristina Deh- Lee, RCAC 9 Chair Engracia López, RCAC 10 Kristina Chung, Community Outreach Field Specialist, CO&E Aida Aguilar, RCAC 10 Chair * Estela Vejar, RCAC 11 Auleria Eakins, Community Outreach Manager CO&E Elda Sevilla, RCAC 11 Chair, ECAC Chair Savy Pol, CCI Area 4 Jerry Edmond, CCI Field Specialist, CO&E Silvia Poz, At Large Member Whitney Franz, Poject Manager, Quality Improvement Demetria Saffore, At Large Member Felicia Gray, Community Outreach Liaison CO&E Hilda Herrera, Community Outreach Liaison CO&E * Excused Absent ** Absent Judy Hsieh Bigman, Resource Specialist, CO&E *** Via teleconference Devina Fan, Health Promoter Program Manager CO&E Susan Ma, CCI Field Specialist, CO&E Frank Meza, Community Outreach Field Specialist, CO&E Roland Palencia, Director, Community Benefits Department Jose Ricardo Rivas, Community Outreach Liaison CO&E Mike Shook, Director, Quality and Improvement Hilda Stuart, Committee Liaison, Board Services Paola Valdivia, Special Projects Manager Eduardo Kogan, Interpreter Prity Thanki, Local Government Advisor, Government Affairs Sina New, Interpreter Martin Vicente, Community Outreach Field Specialist CO&E Paulina Laurent, Interpreter Maria Weaver, Member Retention Unit, Member Services. AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN ITEM/PRESENTER CALL TO ORDER Elda Sevilla, ECAC Chair, called the meeting to order at 10:05 a.m.
APPROVE Chairperson Sevilla announced the following changes to todays’ meeting agenda: Item IV. (D) Approved MEETING AGENDA Health Services Report will not be provided, item VII. (B) Behavioral Health Services will be unanimously as discussed earlier on the agenda, and item IV. Member issues will not include Chair’s presentation amended.
102
APPROVED
of new issues submitted to the Interdisciplinary Team (IDT). During this agenda item, Mike 12 AYES (Aguirre, Shook, Director of Quality Improvement, will report on the status of previously submitted issues, and Cadena, Deh-Lee, answer questions from the Committee. The agenda for today’s meeting was approved as Guadarrama, amended. Meza, Parra, Poz, Romero, Saffore, Salvatierra, Savage Pinkney and Sevilla.)
APPROVE Carlos Aguirre, RCAC 2 Chair, noted an error under approval of meeting minutes. He noted Approved MEETING MINUTES that he only abstained for the ECAC Chair election. The February 11, 2015 meeting minutes unanimously as
were approved as amended. amended by Mr Aguirre. 12 AYES PUBLIC COMMENT: Cynthia Conteas-Wood, RCAC 3 member, noted inconsistency on the meeting minutes, and requested that all questions be documented on the minutes, to help the reader have a better understanding of the discussion1.
STANDING ITEMS ECAC CHAIRPERSON Chairperson Sevilla presented the following motion: Approved REPORT unanimously. Motion ECA 100: To approve the following candidate(s) to the Regional Community 12 AYES Elda Sevilla, Chair Advisory Committees (RCAC) as reviewed by the Executive Community Advisory This motion will Committee (ECAC) during the September 10, 2014 ECAC meeting. be forwarded to
the next Board of Name RCAC # Type of Member Governors meeting Shekelia Harvey 3 Consumer Partner on April 2. BOARD MEMBER Hilda Pérez, Consumer Board Member, reported that the Board met on March 5, 2015. REPORT The Board approved several motions. (A list of the motions approved can be requested from the Board Services Department). o The Board approved schedule changes to the March, April and July Executive and Finance & Budget Committee meetings. The new meeting dates are March 24, April 30, and July 22. o The Board also approved a motion to delegate authority to the Finance & Budget Committee, to approve agreements necessary for L.A. Care to meet the National Committee for Quality Assurance (NCQA) Standards for Member Connection including vendor contracts for member self-management tools and web portal.
1 ECAC approved a motion at the March 2013 ECAC meeting, to address this concern. Future meeting minutes will reflect this request.
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Elda Sevilla, ECAC Chair, Demetria Saffore, RCAC 1, Herceys Donis, RCAC 4, Lourdes Servin, RCAC 5, Mary Romero, RCAC 6, Fátima Vázquez, RCAC 7, María G. Cervantes, RCAC 8, Blanca Villagrán, RCAC 10, María Angel Refugio, RCAC 11, and Andria McFerson, CCI Area 3 attended the meeting. ECAC member Saffore, advocated for a Family Resource Center (FRC) in the Antelope Valley area and requested that minutes of the ECAC ad hoc Committee be available to members. Member Sevilla also advocated for an FRC in the Pomona area, and for the reinstatement of the Active Steps Program in all RCAC regions. The Board welcomed Kimberly Uyeda, MD, as a new member of the Board of Governors. Dr. Uyeda is the Director of Student Medical Services for the Los Angeles Unified School District, and was nominated by the American Academy of Pediatrics Califonria District IX to replace Dr. Thomas Klitzner on L.A. Care’s Board of Governors. Dr. Uyeda has been an active member of the Children Health Consultant Advisory Committee (CHCAC). Board Member Pérez talked about the Interdisciplinary Committee and its efforts to develop a meanigful process to resolve member issues submitted by ECAC and RCACs.
Board Member Pérez requested that an invitation to the April 30 RCAC health and advocacy conference be extended to John Baackes, L.A. Care’s new Chief Executive Officer (CEO). Maribel Ferrer, Senior Director of Member and Medi-Cal Operations informed the Committee that Mr. Baackes has confirmed his attendance, and will offer opening remarks at the conference.
Board Advocate Member López noted that at the last Board meeting he requested that an assessment of the needs for the entire L.A. Care membership be conducted, to identify strategies for possibly establishing FRCs in all of the RCAC areas. Board Member López had previously requested that a presentation on L.A. Care’s Community Health Investment Funds (CHIF) be provided at ECAC, and a presentation will be delivered later on today’s agenda. In addition, he requested staff to research on the possibility to stream Board meetings to make them accessible via television or internet in an effort to improve access.
Board Member López informed the Committee that he worked for the City of Los Angeles for over 20 years, and had a brief tenure with the Metropolitan Transportation Authotity (MTA). He announced that as of January 12, 2015 he was appointed as Director of Workforce Development at AltaMed Health Services. Board Member López noted that although he is now working for a healthcare provider, his role on L.A. Care’s Board of Governors is to advocate on behalf of all of L.A. Care members.
Board Member López encouraged ECAC and RCAC members to continue submitting their questions and concerns, so that he, and Board Member Pérez can inform the Board and its various Committees.
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L.A. CARE SENIOR John Wallace, Interim Chief Executive Officer (CEO), reported: STAFF REPORT Announcements As mentioned earlier by Board Member Pérez, Board action was required to help the organization comply with new NCQA Standards for Member Connections (MEM) related to member engagement. L.A. Care must have a secure portal for members to be able to access certain information such as prescription history, self-health information, as well as the ability to refill prescription medication, replace a member identification card, and other functions that currently require a phone call. This system must be implemented by July 2015 to retain accreditation. L.A. Care will ensure that the portal is also accessible through a phone application. In regards to the request made by Board Member López to stream Board meetings, Mr. Wallace noted that staff is working on this request, and that the service may be available at the May Board meeting. He noted that previous notice will be given to ensure public participation. John Baackes, CEO is relocating from Philadelphia and will start on March 23, 2015. He conducted a site visit on March 9, 2015 and met with several staff to review L.A. Care’s operations. Staff has diligently worked on a smooth transition plan for Mr. Baackes. On behalf of L.A. Care’s Management team, Mr. Wallace congratulated Board Member López in his new position with AltaMed. He noted that AltaMed is not only an important partner to L.A. Care but a vast health care provider, and innovator in the community. L.A. Care’s spending practices were recently reviewed by the Los Angeles County Auditor Controller. Based on the recommendations from the audit, L.A. Care will be making a number of changes to the approval process of discretionary items mainly around meals and travel in an effort to develop a more transparent process. More information will be provided at future meetings. The new Martin Luther King (MLK) Community hospital will re-open in the summer of 2015. The new hospital is a pleasant and modern facility with single occupancy rooms. L.A. Care is working with MLK to ensure that this hospital is an option for L.A. Care members. The Board was informed of a recent cyber-attack to Anthem. This attack may have impacted some of L.A. Care’s members assigned to Anthem however Anthem has not provided L.A. Care with detailed information on who those members are. L.A. Care continues to work with Anthem to identify the affected members. Anthem will send letters directly to those members, to explain the issue and inform them on next steps. The budget for the Healthy Kids 0-5 program is set to end June 30, 2015. L.A. Care is working diligently to keep the program open until December 31, 2015. There are 350 children enrolled in the program, however the program is now closed to new enrollment. L.A. Care will work with the County and community clinics to find alternate programs for
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impacted members to continue receiving appropriate care.
Membership The L.A. Care membership increased by 15,860 members, of which 10,931 joined L.A. Care’s direct Medi-Cal line of business (MCLA). There are approximately 14,000 members currently enrolled in the Cal MediConnect (CMC) program, also known as the duals pilot. All health plans participating in the CMC program are experiencing low membership due to the high opt-out rate. L.A. Care is developing strategies to outreach to all eligible individuals. Open enrollment for Covered California was extended through April 30, 2015. Mr. Wallace asked Committee members to refer eligible individuals to the Covered California website to submit an application. The L.A. Care membership for the Covered California product is at approximately 22,000.
Cristina Deh-Lee, RCAC 9 Chair, suggested that the new phone application include the ability to submit complaints, and get a prompt response, in reference to the NCQA MEM Standards. Mr. Wallace will confirm if this is an option and will note this suggestion as a priority. Auleria Eakins, Manager, CO&E asked if L.A. Care has considered hosting a consumer focus group to seek input on the process for the NCQA Standards for Member Connections (MEM). Mr. Wallace acknowledged the idea, and advised her to speak to the staff leading the project, Jim Banks, Senior Director, Quality Improvement and Health Assessment, and Bruce Pollack, Senior Director, Project Management Office.
Board Member Pérez asked if a demonstration can be provided to the Committee once the web portal and phone applications are implemented. She also asked about L.A. Care’s strategy to advertise these new tools to its members. Mr. Wallace acknowledged the request and requested staff to schedule a presentation about this topic.
Dove Savage-Pinkney, RCAC 6 Chair, noted concerns about the closing of programs, such as Healthy Kids as referenced by Mr. Wallace, and asked if members receive information about other available options, and guidance on how to make an educated decision. She asked if members are able to compare benefits, and inquired on ways in which this information is relayed to the members. Mr. Wallace informed that the information that can be provided to members depends on specific program regulations. He also informed about the Health Insurance Counseling and Advocacy Program (HICAP), which provides accurate and unbiased information to clients. Mr. Wallace requested an informational presentation be provided to this Committee about community based organizations that can help answer questions from the consumers, in addition to information about available program options, and tips on how the selection process works.
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Ms. Savage Pinkney shared concerns in regards to the status reports received from the Interdisciplinary Committee. She opined that member’s identity can be protected as long as the status report does not include the members’ name. Mr. Wallace informed about regulations protecting privacy breaches, including members’ name, zip codes, and other identifiable information and noted that L.A. Care is working on ways to improve the delivery of information.
Lidia Parra, RCAC 3 Chair informed that some RCAC 3 members expressed that CVS refused to fill their prescription medication, and referred them to other pharmacies because they no longer have a contract with L.A. Care. Mr. Wallace informed that CVS is a contracted pharmacy, and part of L.A. Care’s network. He asked Ms. Parra to advise members to call the Member Services Department for an investigation of the issue. Romalda Meza, RCAC 5 Chair informed that she received a letter from L.A. Care stating that CVS would no longer work with L.A. Care. Ms. Ferrer noted that she is not aware of this notice but will follow up on this issue.
Board Member López publicly acknowledged Mr. Wallace for his support as interim CEO, and the entire leadership team for a job well done.
PUBLIC COMMENT: Ms. Conteas-Wood asked if MLK hospital is a County facility. Mr. Wallace informed that MLK is a private community non-profit hospital, not governed by the County Board of Supervisors. The hospital has its own independent Board of Governors which includes former L.A. Care Board Member Robert Tranquada, MD. Elaine Batchlor, MD, MPH, former Chief Medical Officer at L.A. Care, is the CEO at MLK.
HEALTH SERVICES This item was not discussed. REPORT
GOVERNMENT AFFAIRS Prity Thanki, Local Government Advisor reported (A copy of the report can be requested through the UPDATE CO&E Department):
Federal Judge Ruling on the expanded Deferred Action for Parental Accountability (DAPA), and Deferred Action for Childhood Arrivals (DACA). On February 16, 2015, a federal judge issued an order that temporarily blocks President Obama’s executive action regarding DAPA and DACA. The judge ruled that these two programs should not move forward because Texas and 25 other states are challenging them. The Obama Administration is acting quickly to reverse the judge’s decision but the start date of these programs may be delayed. DACA was supposed to begin on February 18, 2015 and DAPA was scheduled to start in mid-May 2015. This ruling only affects the expanded DACA and DAPA. Applications for the original
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DACA issued in 2012, renewals, and extensions under original DACA are not affected. L.A. Care’s Government Affairs Department is monitoring this issue and will keep the Committee informed.
Covered California Extended Enrollment As mentioned earlier by Mr. Wallace, Covered California is offering a special enrollment extension until April 30, 2015. This extension is for people who say they were not aware of the tax penalty for being uninsured. In 2014 the tax penalty for being uninsured is $95 per adult or $47.50 per child under 18 years of age. The maximum penalty is $285 per family or 1% of income. In 2015 the penalty will increase to $ 325 per adult or 2% of income, and in 2016 it will increase to about $695 per adult or 2.5% of income.
Ms. Thanki encouraged Committee members to let people in the community know of the extended enrollment deadline to help them avoid paying the tax penalty.
Covered California Adult Dental Coverage In August 2014, Covered California announced that it would offer adult dental coverage as an add-on plan for an additional cost starting in 2015. On February 24, 2015 Covered California announced that they will not offer a dental coverage option in 2015 due to challenges with their current registration system. Pediatric dental coverage is already included as an essential health benefit for all children’s health plans.
Mandatory Open Enrollment for Medi-Cal Managed Care At the last meeting, the Committee was informed that the Department of Health Care Services (DHCS) is proposing legislation that would lock Medi-Cal beneficiaries under family and child aid codes in their managed care plan for one year, and only allow them to change plans during a mandatory open enrollment period. This proposal would have no impact on the Medi-Cal Expansion population. Advocates oppose this proposal because they think it limits choice, and may limit continuity of care with the same provider, if a beneficiary is not able to change plans to access their provider. L.A. Care Government Affair Department will continue to monitor this proposal, and will keep the Committee informed.
PUBLIC COMMENT: Russell Mahler, RCAC 1 member, asked if DHCS will restore adult dental benefits in the future. Ms. Thanki informed that adult dental benefits were terminated several years ago, and Advocates continue asking for a restoration of these benefits. Although there have been discussions
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around this issue, there is no specific timeline for these benefits to be restored.
Ms. Deh-Lee asked for clarification if Medi-Cal beneficiaries are losing their dental benefits. Ms. Thanki noted that the dental information for adults as provided at today’s meeting pertains to the Covered California program not Medi-Cal.
Ana Romo, RCAC 8 Chair, ECAC Vice Chair, asked for validation on the following statement that she has heard in the community: Undocumented individuals who apply for a drivers’ license do not qualify for DAPA. Ms. Thanki informed that DAPA and DACA are both immigration issues, and noted that she does not have information on how they relate to drivers’ license.
Ms. Savage Pinkney asked if any organization is taking s proactive steps to inform the public about Covered California, and tax penalties that would be incurred if uninsured. Ms. Thanki informed the Committee that this is a nationwide issue, and noted that Covered California has increased its marketing and advertising campaigns to address this issue.
PUBLIC COMMENT: Estela Vejar, RCAC 11 member, asked if the delays with DACA and DAPA have an impact on individuals who filed in 2012 and are currently in the renewal process. Ms. Thanki informed the Committee that there should not be a delay for individuals that applied in 2012 as long as they are not in the expanded DACA. Ms. Thanki reiterated that DACA and DAPA are immigration issues, and L.A. Care’s Government Affairs Department provides updates as a courtesy to members, as it may be an important issue for many members. She advised to contact the Immigration and Naturalization Services Agency to obtain more information about these programs.
HEALTH PROMOTER Devina Kuo Fan, Health Promoter Program Manager, reported: PROGRAM UPDATE Health Promoter’s (HPs) continuing education meetings-Group A (2012 graduates) and B (2014 graduates). HPs met on February 27, and had a practice session on MyPlate, and received updates on immigration reform (DACA, DAPA). CO&E is monitoring President Obama’s executive action, and keeping HPs informed. HPs met also met on March 6, and received information on State budget, and training on how to communicate with Your Doctor Curriculum. HPs also participated in a telephone activity to show the importance of effective communication. HPs will meet again on March 27. This session will focus on mental health and self-care, and HPs will also have an opportunity to practice the How to Communicate with Your Doctor Curriculum, and effective communication skills learned previously.
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HPs in the 2015 Active Steps Program (ASP) RCACs 1,6,7. On February 25, HPs participated in a data collection training session in Lancaster. On February 26, HPs received training on motivational interviewing part I. The second part of this training will be done on March 20. The ASP in RCAC 1 began on March 9. HPs assisted with data collection, body measurements and surveys. On March 18, they will be teaching ASP participants on how to set specific, measurable, attainable, realistic, and time-bound (SMART) goals.
HPs in the Community HPs in groups A and B continue providing presentations in the community on access to care (urgent care versus emergency care), and health care reform. HPs will participate in the Animo College Prep. Academy, 2nd Annual Family Night. HPs will host a resource table for continued collaboration with Green Dot public schools (flyer can be requested through the CO&E Department).
Spring RCAC Health Advocacy Conference The three interns from the University of Southern California are developing a fun and interactive activity on how a bill becomes a law. HPs will showcase a mental health theater to introduce the Behavioral Health Services section of the Agenda.
Affordable Care Act (ACA) As noted earlier, special open enrollment period was extended until April 30, 2015. People who enrolled before the 15th of the month will be covered on the 1st day of the following month. A quick overview of the Covered California website was conducted to demonstrate how to find information regarding local events, certified enrollment locations, agents, and county resources. The web based tool allows people to search for certified insurance agents in California using name, zip code, and preferred language. www.coveredca.com Examples of tax penalties were provided for single individuals and families. In 2014 the penalty is $95 or 1% of income. Ms. Fan noted that the penalties will increase in the years to come.
AT-LARGE MEMBER Demetria Saffore, and Silvia Poz, At-Large Members, reported (a copy of the reports can be requested by UPDATE contacting CO&E): (MEMBER The first CCI consumer Council meeting for Area 3-South Los Angeles took place on February RECRUITMENT/CCI) 25, 2015 from 10:00 a.m. to 12:30 p.m. at L.A. Care’s Inglewood FRC. At this meeting, CCI
Council meeting learned about the CCI Council, and participated in an educational session presented by Bryan Gaines from USC. A few RCAC 6 members were also in attendance to Executive Community Advisory Committee March 11, 2015 110 APPROVED
offer support and learn more about the CCI Council.
Susan Ma, CCI Field Specialist, reported: The CCI consumer Council meeting in Area 2-San Fernando Valley will take place on March 25, 2015 from 10:00 a.m. to 12:30 p.m. at L.A. Care’s Pacoima FRC, at 10807 San Fernando Blvd., Pacoima, CA 91331. The CCI Council from Area 1-Antelope Valley will be joining this meeting. Based on the need of the CCI Council, it was determined that the Councils will meet on a bi- monthly basis rather than on a quarter basis.
Board member Pérez asked for information on attendance at the CCI Council meeting in Area 3, and if transportation is provided for members of the public who wish to attend CCI Council meetings in their area. Ms. Ma informed that there are a total of six Council members in Area 3, three of which have dual RCAC/CCI membership. Seven members of the public also attended the meeting on February 25. Ms. Ma informed that transportation will be provided to potential CCI Council members who wish to attend a meeting in their belonging area. She reminded everyone that the CCI Council meetings are public and anyone is welcomed to attend.
Board member López asked about L.A. Care’s strategies to distribute materials, and outreach to members for upcoming CCI Council meetings. Ms. Eakins informed that L.A. Care does specific zip code mailings to members who live within a certain mile radius from where the CCI Council will be held. Ms. Eakins noted that L.A. Care has not been successful with this outreach mechanism, thus staff is identifying other outreach strategies such as partnering with Regional Centers and Senior Centers in the CCI Council Areas. Current CCI Council members have also been asked to assist L.A. Care with outreach efforts.
In reference to Board member López’s question, Board member Pérez inquired about proactive steps that L.A. Care staff are taking to disseminate the information throughout the community, and asked about the measures that L.A. Care is taking to address the high CCI/CMC opt-out rate in the county. Ms. Ferrer informed the Committee that one of the reasons for the high opt- out rate in the program may be due to non-contracted Medicare providers asking their patients not to join. Ms. Ferrer added that the high opt-out rate is a country-wide issue and the Centers for Medicare and Medicaid Services (CMS) and the DHCS are aware of the issue and have begun working with health plans to identify strategies and mechanisms to help reduce the high opt-out rate.
In regards to L.A. Care’s CCI Council meetings, Ms. Ferrer noted that staff is actively looking for other opportunities to engage consumers, and acknowledged the value of the CCI Council meetings. In addition, Ms. Eakins informed that other mechanisms for outreach efforts include collaborating with other departments to help increase awareness about the CCI Councils. Examples of those collaborations are providing follow up to potential members, as a result of
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the outbound calls from the Member Outreach & Engagement (MORE) department, and working with the Communications department on a webinar for community clinics and community partners to provide more information about the CCI Councils.
Ms. Poz reported that there is one candidate for RCAC membership approval. She reviewed the membership attachment (Attachment can be requested through the CO&E department). Five interest cards were received on February 2015 from RCACs 3, 4, and 9. A total of 313 interest cards have been received to date. Not all interest cards are processed due to lack of eligibility, or because L.A. Care is looking for specific product lines to reflect the overall L.A. Care membership. Fifty two new members have joined the RCACs since membership reopened.
Board member Pérez noted the number of vacancies across all RCACs, and suggested the need to have a discussion around member recruitment. Ms. Deh-Lee requested that a training session on how to outreach to community partners be provided to the Committee. Ms. Eakins noted that the Managed Care Plan Consumer Advisory Committees acknowledged that all health plans are having difficulties recruiting advisory members, and they are in the process of forming a special Committee to discuss ideas around meeting time, location, incentives and refreshments. In reference to the suggestion made by Ms. Deh-Lee, Ms. Ferrer indicated that a training session on how to outreach, and recruit community partners can be provided to the Committee in the future.
Board member López acknowledged past success related to the RCACs advocacy work on the proposed RCAC term limits. He noted the need for RCACs to continue to work closely with the CO&E staff to identify individual strategies for each RCAC, depending on the needs of the specific communities within a RCAC. Board member López noted that Howard A. Kahn, former L.A. Care CEO, once indicated that ECAC and the RCAC are an integral part of the organization, and have accessibility to the organizations’ Board of Governors and to the CEO. Board member López requested that a plan be developed to increase RCAC membership.
Ms. Poz requested L.A. Care’s staff guidance, support, and participation when attending a meeting at a local regional center. She asked if RCAC and CCI Council meetings can be held at the regional centers. Ms. Ferrer reiterated statement from Board member López and noted that each RCAC will have different needs, and will require a different strategy. She requested that these types of request be communicated with the assigned Field Specialist.
PUBLIC COMMENT: Ms. Conteas-Wood noted that each RCAC is unique, and that all RCACs do the same but in different ways. She opined that there is room within the RCACs to include people who meet the basic criteria but not all the criteria that L.A. Care is looking for in new members, especially in RCACs with great declines. Ms. Conteas-Wood suggested allowing a number of seats to be
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filled with certain available member categories while continuing to recruit for the rest. Ms. Ferrer acknowledged the concern and suggestion. She reminded the Committee that the RCAC membership must reflect the diverse population of the overall L.A. Care’s membership.
NEW BUSINESS BEHAVIORAL HEALTH Clayton Chau, MD, Medical Director, Behavioral Health & Provider Continuing Education Departments SERVICES (BHS) Reported: Early Periodic Screening Diagnostic and Treatment Services (EPSDT), is a set of benefits established in 1967 by the federal government. It is required that all Medicaid programs in the country provide EPSDT for children and youth under 21 years old. The purpose of EPSDT is to ensure that services are available and accessible, and to assist eligible children and youth to obtain the needed health care services. Commercial insurance plans have similar set of requirements for children and youth under 21 however these requirements are less than those included in EPSDT for Medi-Cal members. L.A. Care will co-sponsor a conference about EPSDT on Saturday, March 21, 2015. The conference is targeted to providers and clinicians. A primary care physician should do EPSDT screening when the child enrolls in their membership panel, and annually throughout the screening process specifically around immunizations. The American Pediatric Association also requires pediatricians to conduct certain physical exam screenings on an annual basis. A family can also request a pediatrician to conduct a complete screening when their child is sick or if they suspect their child has a disability. The components of EPSDT are health and developmental history including a complete physical and mental health exam. The physical exam includes: Immunizations, laboratory tests, led toxicity tests, blood tests, sickle cell anemia (particularly for African American children), health education counseling, vision, dental and hearing serices, in addition to mental health and substance abuse. At a prior meeting the Committee learned about the Applied Behavior Analysis (ABA) for children, related to Autistic Spectrum Disorder (ASD). Most states, including California decided to include ABA services under EPSDT so that all children and youth under 21 have an opportunity to be screened for ASD. The Health Resources and Services Administration (HRSA) published an article for parents, related to EPSDT, (A copy of the article will be forwarded to the CO&E Department for translation and distribution). Under the Medi-Cal program occupational (OT), physical (PT) and speech therapy (ST) for adults is limited to two times per month, but there is no limit for children. Upon evaluation, a qualified licensed therapist in the respected field, can determine the number of sessions Executive Community Advisory Committee March 11, 2015 113 APPROVED
that the child or youth under 21 will need per week or month. If a pediatrician denies or limits the number of OT, PT or ST session for a child, the parent should inform L.A. Care for intervention. The purpose of the EPSDT is to screen, detect and treat early before the condition worsens. Medical necessity for adults is different than medical necessity under EPSDT. Under EPSDT medical necessity is a treatment that will help a child function better and adjust better in their community. DHCS continuously reminds health plans about EPSDT. On December 12, 2014 they reissued a letter to the plans reminding them of EPSDT, and the importance of conducting the screening so that children and youth under 21 receive timely services if needed.
Board member Pérez asked Dr. Chau to explain about Beacon and how it relates to BHS. Dr. Chau informed that Beacon is a vendor that contracts with L.A. Care to provide services through their network of psychiatrists and therapists to provide mental health services. A physician can refer a child and youth under 21 to Beacon, if they require services from a mental health provider. He noted that the BHS department does not do direct care for members. BHS monitors Beacon and ensures access and quality of services.
Ms. Deh-Lee requested a written summary of this presentation. Dr. Chau noted that the information will be recorded in the meeting minutes.
Ms. Parra that her daughter’s pediatrician referred her to the school district for speech therapy because Medi-Cal would not cover these services. Dr. Chau informed about educational related conditions, and noted that the school district would be responsible if the condition only occurs in the school environment, and during the school session. However schools have to assess if it is medically necessary to treat the condition. If the school is contracted with Medi-Cal, it can bill the health plan for those services as Medi-Cal is the primary payer. Dr. Chau asked Ms. Parra to contact L.A. Care’s Member Services for a follow up.
PUBLIC COMMENT: Engracia López, RCAC 10, informed the Committee about the increased number of parents who do not want to get their children immunized. Dr. Chau noted that parents currently have the ability to ask their children’s provider for a waiver not to immunize their children.
Ms. Conteas-Wood informed the Committee that a parent can request not to immunize their children due to personal beliefs or medical waivers. She noted that medical waivers are done when the child has a condition that may be adversely affected by immunization.
STANDING ITEMS Continued COMMUNITY This item was not discussed.
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ENGAGEMENT
ECAC members NEW BUSINESS Continued COMMUNITY HEALTH Roland Palencia, Director, Community Benefits Department presented: (A copy of the presentation INVESTMENT FUNDS can be requested through the CO&E Department): PROGRAM(CHIF ) The Board of Governors established the CHIF program in the year 2000. The goals of the program are to improve community and public health, expand health insurance coverage, and strengthen the safety net (including private, non-profit clinics, and Los Angeles County Department of Health Services). There are two overall strategies: o To align CHIF grant-making to L.A. Care’s business needs, and priority goals that will benefit L.A. Care members. Through this grant-making process L.A. Care helps clinics develop infrastructure, which allows them to resolve internal issues. o To provide general support to projects that can benefit all uninsured or underserved, including L.A. Care members. Since the start of the CHIF fund, over $46.2 million has been granted to a total of 372 projects at community clinics and DHS. Last year, a total of $3,810,000 was granted to fund 31 initiatives and ad hoc projects. L.A. Care has two approaches to funding: Initiatives and Ad Hocs. o Initiatives have specific parameters and strict criteria; a timeline, and maximum amount of funds that an agency can apply for, in addition to specific details on the qualifying projects. Some recurring initiatives funded by L.A. Care include: the Asthma Community Health Improvement, and the Robert Tranquada M.D. Safety Net. o Ad Hocs are special projects that don’t fit any of the initiatives. Ad Hoc grants include: New models of care for high-need, high cost members, a $200,000 grant provided to the Corporation for Supportive Housing. This grant addressed the special needs of the 10% with the most complex medical, mental, physical and social needs. Another Ad Hoc grant provided last year, was in the amount of $60,000 to the Achievable Clinic. This grant was to obtain special designation from Health Resources and Services Administration (HRSA). This would help increase the amount of compensation for community clinics serving the complex needs of developmentally disabled populations. The CHIF priorities for fiscal year 2014-15 include health care reform, Medi-Cal expansion, and patients with complex needs, strengthening and expanding health information technology Infrastructure (Health Information Exchange Network, eConsult/ eManagement expansion to include behavioral health, and a data analytics project), in addition to oral health, and ad hoc projects.
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L.A. Care funds agencies that meet CHIF guidelines and priorities, and has external community content experts as advisors on its Initiative Review Committees and most ad hocs. This Committee makes recommendations to the Board for approval of funds.
Ms. Parra noted that community clinics mostly serve undocumented and low-income individuals, and asked if anything is available for those with higher incomes. Mr. Palencia informed that community clinics serve everyone including documented individuals who may have private insurance or Medi-Cal. He noted that community clinics also work with a sliding scale and those who have higher incomes may be able to obtain services for a certain fee depending on their income.
PUBLIC COMMENT Ms. Conteas-Wood asked for clarification regarding process related to the Initiative Review Committee and Board of Governors approval, and also asked for the approximate number of applications received on an RFA. Mr. Palencia informed that L.A. Care releases a Request for Applications (RFA) to agencies that meet the criteria. The Initiative Review Committee reviews the applications that are submitted and forwards request for Board approval only if the grant is above $150,000. Mr. Palencia noted that this is a competitive process and some agencies may not get a grant even if they meet the criteria. In regards to the second question, Mr. Palencia noted that L.A. Care usually receives between 27-30 applications for the oral health initiative, but L.A. Care is limited as to how many it can fund. Last year, L.A. Care was able to fund 14 out of 27 applicants.
Board member López noted that the purpose of this presentation is to create awareness, and encourage ECAC to spread the word within their communities about the available grants that L.A. Care offers. Mr. Palencia informed that L.A. Care has funded the majority of clinics in Los Angeles County, and he encouraged Committee members to contact him if they have any questions regarding a particular clinic.
Carlos Aguirre asked if there is a timeframe for agencies to submit their application. Mr. Palencia informed that there are specific deadlines for those applying for funds through initiatives however applications for the ad hoc grants have rolling deadlines.
OLD BUSINESS ECAC AD HOC Carlos Aguirre, RCAC 2 Chair reported: COMMITTEE-BOARD At the December 10, 2014 meeting, ECAC formed an ad hoc Committee to review the ELECTIONS election process in preparation for 2016 elections, and report back to ECAC. The ad hoc Committee met on Wednesday, February 11, 2015 immediately following the regularly scheduled ECAC meeting. Carlos Aguirre, RCAC 2 Chair, Silvia Poz, At Large Member, Ana Romo, RCAC 8 Chair, and Demetria Saffore, At Large Member attended this meeting. Executive Community Advisory Committee March 11, 2015 116 APPROVED
The Committee reviewed the election process for Consumer and Consumer Advocate as approved by ECAC for the 2012 elections, and discussed potential improvements to the process. The details of the potential improvements will be brought to ECAC when finalized by the ad hoc Committee. The ad hoc Committee members agreed to meet again after the regularly scheduled ECAC meeting on May 13. This meeting will serve to refine the improvements, and discuss recommendations to ECAC to improve the election process for 2016. The election process should be completed by the end of 2015. Board Member Pérez noted that at the last Board meeting, Ms. Saffore informed the Board of Governors about the lack of meeting minutes for the 2016 Board Elections ad hoc Committee. Board Member Pérez also noted that minutes for an ad hoc Committee that met to review the roles and responsibilities of the At Large members, were not available either. Board Member Pérez asked Committee members if they feel that is necessary that minutes be taken at ad hoc Committees so that everyone is kept informed of the progress being made and for transparency purposes. PUBLIC COMMENT Ms. Conteas-Wood noted that the suggestions and recommendations made by the ad hoc Committee should be taken to the RCACs for additional comments. Ms. Savage-Pinkney and Ms. Poz agreed that progress reports be made available to ECAC and the RCACs to seek input. Ms. Chitica informed the Committee that the recommendations made by the ad hoc Committee will be brought to ECAC for review. She noted that ECAC will determine if these recommendations ought to be taken to the RCACs for additional feedback. Ms. Chitica reminded the Committee that the ad hoc Committee was tasked to provide recommendations to improve the election process, and noted that these recommendations will be presented to ECAC for review and discussion. If the Committee decides to take these recommendations back to the RCACs, the item will be placed on the Agenda for each RCAC to hold a discussion. ECAC will review all the recommendations and will approve recommendations and revisions to the election process.
RCAC MEMBERSHIP Ms. Eakins reported: AND RECRUITMENT Over the past couple of months, staff has heard multiple concerns related to member recruitment, and thus it has been decided to eliminate the RCAC Ambassador program and request that all RCAC members assist with recruitment efforts in their assigned RCAC with the diligent support from their Field Specialist.
Board Member Pérez requested a guideline be provided clarifying the recruitment process, goals, eligibility criteria and deadlines. Ms. Eakins informed the Committee that CO&E is working
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with other departments such as Cultural & Linguistics, MORE on materials that require review and approval from the Regulatory Affairs and Compliance department, and the Department of Health Care Services. She noted that there are language barriers in all of the RCACs and informed the Committee that the materials will be translated into several threshold languages. She reminded Committee members of the importance of collaborating with the assigned staff to attend community meetings, health fairs and having available materials to distribute.
2015 ADVISORY Ms. Chitica reported: MEMBER At the last meeting the Committee was informed of RCAC work plan events for 2015. Some ACKNOWLEDGEMENT Committee members shared concerns related to the clarity of the commitment required from FORM members. The RCACs that met in February held work plan discussions during their meetings, and were able to volunteer for community meetings or events. Staff developed a form which will be distributed at the March and April RCAC and CCI Council meetings. The form is being translated to Spanish and Khmer. (This form is currently available in English, and a copy can be requested through the CO&E department). The form includes the following requirements: Attending RCAC or CCI Council meeting (Including RCAC work plan events, and other L.A. Care sponsored events). RCAC members may not have more than two absences (excused or unexcused) and one medically excused absence (with doctor’s note) in a fiscal year. Attending ECAC and Board of Governors meeting as assigned. Attending CO&E conferences as scheduled. Attending two community meetings in their assigned areas from February 2015 through September 2015. Attending one tabling event prior to September 30, 2015. Following the L.A. Care Code of Conduct, Advisory Committee Member Standards of Behavior, and the Standard Advisory Meeting Rules.
During the March and April meetings, members will be asked to sign, and date the form to acknowledge receipt and understanding of their duties as Advisory Committee members.
Ms. Savage-Pinkney noted that allowed number of absences in a year makes it difficult for members, and further noted that establishing strict rules on attendance contradicts the overall goal of increasing membership in the RCACs.
ECAC LEADERSHIP Ms. Chitica informed that the next ECAC leadership training is scheduled on Monday, March TRAININGS 23, 2015, from 8:30 a.m. to 3:00 p.m., at L.A. Care Health Plan. Staff will make phone calls to confirm attendance. RCAC Vice Chairs are welcomed to attend.
STANDING ITEMS (Continued)
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MEMBER ISSUES Board Member Pérez noted that the English issue summary received in the mail included an RCAC 1 extra issue that was not included in the Spanish issue summary. Ms. Ferrer indicated that this RCAC 2 was sent in error, and a retraction was sent to correct that. That particular issue will go through RCAC 3 the appeals and grievance process for review and resolution. Board Member Pérez read the issue out loud and noted that the member complained about poor customer service received Interdisciplinary from Member Services staff, lack of receipt of a member identification card, lack of timely Committee internal communication to help member access prescribed medication for chronic illnesses, and using processes that lengthened the time to resolve the issue for example using U.S postal mail rather than fax or e-mail. Board Member Pérez noted that many people in the community have expressed dissatisfaction with the services received from the Member Services department. Ms. Ferrer informed the Committee that the issue read by Board Member Pérez is undergoing an appeals and grievance process. She noted that L.A. Care offers members the opportunity to fax documents, and thus the need to investigate further. She noted that the affected member will receive acknowledgement from L.A. Care indicating that the organization is aware of the issues she encountered with the Member Services process, in addition to a written resolution. Ms. Ferrer noted the importance of reporting individual issues and processing them through the appeals and grievances process for proper documentation, and tracking purposes.
Ms. Ferrer reminded the Committee that the purpose of the Interdisciplinary Committee is to review systemic and global issues rather than individual member issues. She noted that L.A. Care must adhere to privacy protection laws and can’t discuss an individual issue in a public setting.
PUBLIC COMMENT: An unidentified member of the public addressed the Committee and introduced herself as the member who encountered the above mentioned issues with the Member Services Department. She reiterated the issues discussed by Board Member Pérez, and added additional detail. She expressed dissatisfaction with customer service and access to care, and demanded an apology from L.A. Care, change in L.A. Care’s policy and procedures, and that members be treated with respect. Ms. Ferrer indicated that this issue is being investigated, and apologized for the inconvenience.
Mike Shook, Director of Quality Improvement reported: Updates to issues were provided in the ECAC meeting materials for review of the Committee. Several issues have been closed since the February ECAC meeting, while a few continue to be in process as the Interdisciplinary Team (IDT) works to investigate and close out the issue in a satisfactory manner. Issue submitted by RCAC 11 in regards to quality of service, and priority of service to cash paying patients, discrimination and service charges to Medi-Cal patients. This issue is in process as it includes multiple unnamed clinics, and it is unknown which of the issues
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occurred at the Pomona Valley Hospital location. Without further detail, the IDT can’t probe specifically but will share in general the member concerns. Another recommended step is to promote a campaign to educate members about their rights. There were concerns in regards to translation and interpretation services, and the IDT will work with the Cultural & Linguistics department to develop an information sheet on how to access interpretation services.
Mr. Shook reiterated the importance of reporting issues to the Member Services department to help track issues and possible trends. He noted that the IDT is working on a meaningful and improved process, and has coordinated standing meetings twice a month to discuss the issues that are presented. He informed the Committee that they will receive an update on the five new issues at the April meeting, and a resolution to those issues at the May meeting.
PUBLIC COMMENT: Ms. Conteas-Wood referred to last month’s meeting minutes, and asked for clarification on the compliance parameters that Linden Optometry was approved for, given that they were not allowing Medi-Cal patients to make weekend appointments. Mr. Shook informed the Committee that L.A. Care follows guidelines from the Department of Health Care Services, which includes timely access to routine and specialist care services. He noted that L.A. Care investigated the issue and no evidence or trends were found however, he noted that L.A. Care continues to monitor this site to prevent this situation from reoccurring in the future. Mr. Shook further noted that at a prior meeting there was a public comment from a member who escalated the concern to the Department of Public and Social Services, and was subsequently able to get a weekend appointment. Mr. Shook encouraged everyone to report any issues they encounter so that the issues can be recorded and tracked.
Ms. Saffore asked for reasons why a Consumer member is not allowed to be part of the Interdisciplinary team to keep L.A. Care accountable. Mr. Shook informed the Committee that the Health Insurance Portability and Accountability Act have strict regulations to protect patient’s privacy. The IDT is comprised of L.A. Care staff from different departments, who work together to try to resolve the issues that are presented, and be accountable to members and the community. Ms. Deh-Lee asked if there is a waiver that a member can sign if they would like their issue to be dealt without any privacy restrictions. Mr. Shook will seek advice from L.A. Care’s Legal Counsel and Regulatory Affairs and Compliance department.
Due to time constraints, the Committee unanimously agreed to continue this discussion at the April meeting.
PUBLIC COMMENT
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ADJOURNMENT Chairperson Sevilla adjourned the meeting at 1:22 p.m.
RESPECTFULLY SUBMITTED BY: APPROVED BY:
Hilda Stuart, Committee Liaison, Board Services ______Samantha Leewood, Interim Manager, Board Services Elda Sevilla, ECAC Chair Date ______
Executive Community Advisory Committee March 11, 2015 121 APPROVED Board of Governors Executive Community Advisory Committee Meeting Minutes – April 8, 2015 L.A. Care Health Plan, 1055 West 7th Street, Los Angeles, CA 90017 ECAC Members RCAC Members/Public L.A. Care Board of Governors/Staff María Adela Guadarrama, RCAC 1 Chair, Adriana Martinez, RCAC 1 Hilda Pérez, Consumer Member, Board of Governors Carlos Aguirre, RCAC 2 Chair Pedro Martinez, RCAC 1 Ozzie López, Member Advocate, Board of Governors Lidia Parra, RCAC 3 Chair Russel Mahler, RCAC 1 John Baackes, Chief Executive Officer Hercilia Salvatierra, RCAC 4 Chair Maricruz Álvarez, RCAC 2 John Wallace, Chief Operating Officer Romalda Meza, RCAC 5 Chair Elizabeth Cooper, RCAC 2 Maribel Ferrer, Senior Directorm Member and Medi-Cal Services Dove Savage Pinkney, RCAC 6 Chair Mirna González, RCAC 4 Idalia Chitica, Community Outreach Lead Field Specialist CO&E Dalia Cadena, RCAC 7 Chair Susana Rios, RCAC 5 Kristina Chung, Community Outreach Field Specialist, CO&E Ana Romo, RCAC 8 Chair, ECAC Vice Rosario Moreno, RCAC 8 Auleria Eakins, Community Outreach Manager CO&E Chair Rosa Santizo, RCAC 9 Jerry Edmond, CCI Field Specialist, CO&E Cristina Deh- Lee, RCAC 9 Chair Wilma Ballew, CCI Council Area 2 Dulce Fernandez, Manager, Facility Site Review, FSR Elsa Gervacio, RCAC 10 Vice Chair , Jean Walker, CCI Council Area 3 Whitney Franz, Project Manager, Quality Improvement Elda Sevilla, RCAC 11 Chair, ECAC Chair Felicia Gray, Community Outreach Liaison CO&E Silvia Poz, At Large Member Hilda Herrera, Community Outreach Liaison CO&E Demetria Saffore, At Large Member Judy Hsieh Bigman, Resource Specialist, CO&E Anna Kazaryan, Quality Improvement Specialist, QI * Excused Absent ** Absent Devina Kuo Fan, Health Promoter Program Manager CO&E *** Via teleconference Susan Ma, CCI Field Specialist, CO&E Frank Meza, Community Outreach Field Specialist, CO&E Peter Prampetch, Analyst, CO&E Jose Ricardo Rivas, Community Outreach Liaison CO&E Mike Shook, Director, Quality and Improvement Hilda Stuart, Committee Liaison, Board Services Paola Valdivia, Special Projects Manager Martin Vicente, Community Outreach Field Specialist CO&E Eduardo Kogan, Interpreter Jasmine Young, Director, Provider Relations, PNO
AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION ITEM/PRESENTER TAKEN CALL TO ORDER Elda Sevilla, ECAC Chair, called the meeting to order at 10:04 a.m. APPROVE Chairperson Sevilla announced that the Government Affairs update will not be provided. She Approved MEETING AGENDA noted that a written report is available in English and Spanish. The Agenda for today’s meeting unanimously was approved as amended. 12 AYES (Aguirre, 122 APPROVED AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION ITEM/PRESENTER TAKEN Cadena, Deh- Lee, Gervacio, Guadarrama, Meza, Parra, Poz, Romo, Saffore, Salvatierra, and Sevilla.) APPROVE The majority of Committee members indicated that they did not receive the March 11, 2015 The March 11, MEETING MINUTES meeting minutes prior to today’s meeting. Committee members unanimously agreed to defer the 2015 meeting approval of the March 11, 2015 meeting minutes until the May meeting. minutes will be approved at the May 13, 2015 meeting. STANDING ITEMS ECAC CHAIRPERSON Chairperson Sevilla presented the following motions: Motion ECA REPORT 100 and ECA Motion ECA 100: 101 were Elda Sevilla, Chair To approve the following candidate(s) to the Regional Community Advisory Committees approved (RCAC), and Coordinated Care Initiative Councils (CCI) as reviewed by the Executive unanimously Community Advisory Committee (ECAC) during the April 8, 2015 ECAC meeting. 12 AYES Name RCAC # Type of Member Motion ECA (Agency, if applicable) 100 and ECA 101 will be Andria McFerson RCAC 6 Consumer forwarded to Higinio Carrillo RCAC 8 Consumer the May 7 Elizabeth Lyons CCI Council Area 2 Consumer Board of Hillary Marides CCI Council Area 2 Consumer Governors Mary Jo Fernando CCI Council Area 2 Consumer meeting. Deaka McClain CCI Council Area 4 Consumer PUBLIC COMMENT In regard to motion ECA 100, approval of RCAC and CCI Council membership, Elizabeth Cooper, RCAC 2 member noted underrepresentation of certain communities such as Asian Pacific Islanders, Seniors and People with Disabilities, and Gay and Lesbian. She asked ECAC Chair about recruitment strategies to include these underrepresented communities. Chairperson Sevilla
Executive Community Advisory Committee April 8, 2015 APPROVED 123 AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION ITEM/PRESENTER TAKEN acknowledged the concern, and deferred to staff for an answer. Motion ECA 101 To approve the election of Elizabeth Bonilla as Vice Chairperson of the Regional Community Advisory Committee (RCAC) of region 4 to complete the remainder of the term until September 2016 as reviewed by the Executive Community Advisory Committee during the April 8, 2015 meeting. BOARD MEMBER Hilda Pérez, Consumer Board Member, reported that the Board met on April 2, 2015, and REPORT welcomed John Baackes as the new Chief Executive Officer of L.A. Care Health Plan. The Board approved several motions. (A list of motions approved can be requested from the Board Services Department). The list is currently available in English, and will be provided to ECAC members in Spanish later this month. o The Board approved Shekelia Harvey as a new Consumer member in RCAC 3. o The Board approved L.A. Care to enter into a three year contract with Inovalon to provide software services and support on Healthcare Effectiveness Data and Information Set (HEDIS) Reporting Solutions for the Los Angeles County Department of Health Services (DHS). The total contract amount is $1,500,000 from May 1. 2015 through June 1, 2018. o The Board approved the execution of a contract with Cerner Wellness Corporation (Cerner), to provide online member health appraisal and self-management tools, as required by NCQA member connections (MEM) standards. This is also a three-year agreement with Cerner Corporation, to provide online member health appraisal and self- management tools for all lines of business with a total cost not to exceed $3,000,000, from April 1, 2015 to June 30, 2018. o The Board approved in concept reforms to expenses related to meals including elimination of alcoholic beverages; creation per person, annual limits by functional activity; and periodic reporting to the Board of Governors; The Board instructed staff to implement necessary changes to administrative policies and procedures; and report back at next Board of Governors meeting on the implementation of changes. Antonia Rodas, RCAC 1, Elizabeth Cooper, RCAC 2, María Méndez, RCAC 5, Norma Aguirre, RCAC 8, SheilaThach, RCAC 9, Estela Vejar, RCAC 11, Demetria Saffore, CCI Council Area 1, Ana María Barrosa, CCI Council Area 2, and Robert Dixon, CCI Council Area 3 attended the meeting. Board member Pérez encouraged everyone to attend a future Board meeting. Dove Savage Pinkney, RCAC 6 Chair joined the meeting. L.A. CARE SENIOR John Baackes, Chief Executive Officer, addressed the Committee, and noted that one of the reasons STAFF REPORT for his interest in joining L.A. Care was the fact that it is a public agency with a strong stakeholder Executive Community Advisory Committee April 8, 2015 APPROVED 124 AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION ITEM/PRESENTER TAKEN Board, which includes member, provider, and county representatives. Mr. Baackes noted that L.A. Care has experienced rapid growth in the last three years, and can utilize its strengths to be a more effective force in the community, advocating for better outcomes, and needed access and services. He informed the Committee that he will make an attempt to attend some of the RCAC meetings in the future. Adela Guadarrama, RCAC 1 Chair, and Ms. Savage Pinkney welcomed Mr. Baackes. Ms. Guadarrama asked for his support in the opening of a Family Resource Center (FRC) in the Antelope Valley area. She also requested that more specialty care be available in the area. She informed the Committee that there are approximately 500,000 residents in the Antelope Valley, and noted that it is difficult to travel to Los Angeles to see a specialist. Mr. Baackes informed the Committee that he will visit all of the FRCs, and noted that staff will identify locations where to establish additional FRCs, and develop a roll out plan over the next few years. Maribel Ferrer, Senior Director, Member and Medi-Cal Services, informed the Committee that L.A. Care is considering two additional centers, the Antelope Valley being considered as one of the two, and noted that Christina Delgado, Administrative Manager, FRCs, and staff are currently researching on demographics as directed by John Wallace, Chief Operating Officer. Ms. Ferrer informed the Committee that Mr. Baackes is supportive of the effort. In regard to specialty care services, Mr. Baackes informed the Committee that L.A. Care is committed to find ways to increase provider participation in the area. PUBLIC COMMENTS Russell Mahler, RCAC 1 member and Ms. Cooper welcomed Mr. Baackes. Ms. Cooper requested that funds for the RCACs and CCI Councils not be decreased or eliminated. She noted the importance of having refreshments available to consumer members participating in these meetings. Ms. Cooper further noted that she read the media article that was recently released, and that at the last Board meeting, Board members did not object to RCAC/CCI Council meeting spending. Additionally, Ms. Cooper requested adequate budget for the CO&E department. L.A. CARE SENIOR Mr. Wallace noted that L.A. Care is on its third week of transition with Mr. Baackes as the new STAFF REPORT CEO. He noted that it has been a smooth transition overall. Mr. Wallace reported: (Continued) County Auditor-Controller Report ECAC/RCAC meeting or activity spending was not the concern in the report’s findings. The main concern in the audit report finding was regarding policies related to L.A. Care’s Management authority on discretionary spending. Policies are being revised to clearly distinguish staff’s authority in regards to spending, and to ensure they are consistent with other public agencies.
Executive Community Advisory Committee April 8, 2015 APPROVED 125 AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION ITEM/PRESENTER TAKEN
Interdisciplinary Committee Mr. Wallace informed that he recently met with Ms. Ferrer, Gertrude S. Carter, MD, Chief Medical Officer, and Auleria Eakins, Manager, CO&E, to address concerns shared by the Committee in regard to the Interdisciplinary Committee. He reported the following: A plan is being developed to work closely with ECAC in an effort to develop an effective structure. Staff will seek assistance from an external entity to interview Committee members and gather ideas and comments. The issue reported last month by a former L.A. Care Covered member resulted in policy changes to ensure that prescriptions be available to member, regardless if there is an eligibility question at the end of the month. Committee’s input is taken seriously and staff follows up to resolve issues accordingly. The challenge is finding a reporting mechanism that will satisfy the need of the Committee without violating privacy laws. Staff would like to develop an appropriate process to report back to the Committee. Membership The L.A. Care membership increased by 30,620 members for a total Medi-Cal membership of 1,643,219 million members. The L.A. Care Covered product continues to grow, with 20,486 members currently enrolled. It is expected that approximately 21,000 members will be enrolled by the end of the special enrollment period. The Cal MediConnect product for dual eligible members currently has 15,065 members enrolled. At the request of Board Member Pérez, Mr. Wallace announced that at the last Board meeting, the Board approved a sponsorship for a Health Pavillion at the 2015 Whittier Narrows Regional Park “Cinco de Mayo” Celebration. Mr. Wallace welcomed everyone to attend this event. In regard to the contract with Cerner, Mr. Wallace explained that this contract relates to the member portal that will allow members to order identification cards, refill prescriptions, and access health education information online. Mr. Wallace noted that L.A. Care is working on a smart phone application at the request of the Committee. Staff will conduct a presentation at a future meeting to gather feedbacks on useful features. Ms. Saffore asked if L.A. Care’s budget is available for public inspection. Mr. Wallace informed the Committee that the budget is reviewed by the Board in September or October, and the budget is available in the Board materials during those months. He noted that a copy of the budget can be requested through Board Services Department. Executive Community Advisory Committee April 8, 2015 APPROVED 126 AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION ITEM/PRESENTER TAKEN PUBLIC COMMENT Ms. Cooper congratulated Mr. Wallace for his successful duration as Interim Chief Executive Officer, and asked if L.A. Care could fund the American Disability Act, and other community events. She inquired about the way in which grants are funded to organizations, and how organizations can apply for these funds. Mr. Wallace informed that the Community Health Investment Program (CHIF) is managed by Roland Palencia, Director of Community Benefits. This program supports services or infrastructure of initiative based projects such as increasing dental access in the community. CHIF also funds ad hoc projects to cover special need in the community, for example the creation of the Antelope Valley Health Center. Mr. Wallace noted that L.A. Care also offers sponsorships through its Communications Department. Organizations can submit their request to Jejuana Johnson. Mr. Wallace directed staff to invite Ms. Johnson to a future meeting to speak to the Committee about the sponsorship criteria. GOVERNMENT This item was not discussed. A written report was distributed to Committee members in English AFFAIRS UPDATE and Spanish. (A copy of the report can be requested through CO&E Department). HEALTH Devina Kuo Fan, Health Promoter Program Manager, reported: PROMOTER PROGRAM UPDATE Health Promoter’s (HPs) continuing education meetings-Group A (2012 graduates) and B (2014 graduates). HPs met on March 27, and received a mental health & self-care training session. During this training session, HPs practiced relaxation exercise, dynamic interaction activities, and discussed holistic health. On April 10 HP Elizabeth Johnson, Executive Director of the California Senior Leaders Alliance, and L.A. Care Health Promoter, will pilot a Coordinated Care Initiative (CCI) training session to obtain feedback from HPs. The training session will also include a presentation from Kahinos Holistic Health regarding nutrition and diabetes. On April 24, Kahinos Holistic Helath will return to present on “Relationship with Sugar”, and Harder +Company Community Research will report on the evaluation results for year one of the HPs program. HPs in Active Steps Program (ASP) in RCAC 1, Antelope Valley On March 20, HPs participated in a motivational interviewing training part 2. Part 3 training is scheduled on April 16. On Monday, April 6, HPs taught “MyPlate for Healthy Menus”, and on April 20, they will teach a third class called “Rethink Your Drink: Be Sugar Savvy”.
Executive Community Advisory Committee April 8, 2015 APPROVED 127 AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION ITEM/PRESENTER TAKEN HPs in the community HPs in group A & B continue to give presentations in the community on health topics and participate in community events. Upcoming event: o In celebration of Cambodian New Year Week, Cambodian HPs will teach “MyPlate for Healthy Menus” to a group of Cambodian Seniors on April 15, 2015. The presentation will take place at the CA Recreation Center in Long Beach. o Cambodian HPs held an extra practice session on March 30 and will practice again on April 9. Spring RCAC Health Advocacy Conference on April 30 University of Southern California interns are working on an interactive activity of How a Bill Becomes a Law. Reviewing the California legislature (Senate, Assembly), SB4 Health For All Act, and SB 103 Soda Labeling Bill. HPs will perform mental health theater to introduce the Behavioral Health Services section. Theater auditions will take place on Friday, April 10, and rehearsals will be held on Monday, April 13 and Friday, April 24. ACA update Committee members were encouraged to remind people of the April 30, 2015 deadline of the special enrollment period for people who didn’t know or understand the “fee” for not enrolling in coverage. Board member Pérez inquired on the status of a prior request made by Chairperson Sevilla in regard to the ability to host an ASP in RCAC 11. Ms. Ferrer acknowledged that the request has been submitted, and informed that L.A. Care’s current fiscal year budget included the ASP for some of the RCACs. She noted that the ASP was initially a pilot project that would be evaluated to assess its benefits to the community. Program evaluations prove the ASP to be successful, thus staff is looking into continuing and expanding the program for the next fiscal year beginning on October 1, 2015. Budget planning for the next fiscal year has begun, and a budget for the ASP in all RCACs has been included. Ms. Ferrer noted that Gertrude S. Carter, MD, Chief Medical Officer is supportive of the expansion of the pilot. Board member Pérez inquired about the possibility for her and Board member López to be involved in budget planning discussions. Ms. Ferrer indicated that staff will plan a strategic planning session for next fiscal year as done in the past. She noted that feedback can be provided at ECAC meetings for consideration, and reminded Board member Pérez that the budget is
Executive Community Advisory Committee April 8, 2015 APPROVED 128 AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION ITEM/PRESENTER TAKEN presented to the Board for review and approval. Hilda Stuart, Committee Liaison, informed the Committee that Board Member López sits on the Finance & Budget Committee and thus has an opportunity to review and discuss the budget before the Board of Governors reviews and approves. Auleria Eakins, Manager, CO&E and Idalia Chitica, Lead Field Specialist, will be working with staff on individual RCAC budgets. RCAC Chairs will have the opportunity to review on a bi- monthly basis to discuss spending for special areas. Ms. Ferrer noted that staff has heard concerns in regard to ECAC and RCACs not spending their entire budget, and reminded the Committee that the budget is based on a RCACs full capacity. She noted that the budget allotted would be spent in its totality if RCACs had maximum membership. OVERVIEW OF ECAC Peter Prampetch, Analyst, CO&E, reported (a copy of the report can be obtained by contacting CO&E) REPORTS the total membership in all 11 RCACs is 223 members of which 192 are consumers. There are 162 available seats throughout the 11 RCACs. Mr. Prampetch reminded Committee members to continue their recruitment efforts, and noted that members are removed from the RCACs if they have two consecutive absences. Ms. Eakins requested that Mr. Prampetch includes CCI Council membership to future reports. Fiscal Year 2014-15 Budget Report on First Quarter Total budget for FY 2014-15 is $450,000 of which approximately $129,980 or 30% of the budget was spent in the first quarter. Committee members reviewed expenses incurred in the first quarter and all line items were within budget. Ms. Ferrer requested Mr. Prampetch to include a comparison of each quarter’s budgeted amount versus actual expenses for that quarter. Ms. Ferrer noted the importance of keeping an accurate account on quarterly budget and expenses for future fiscal year’s budget planning. Starting in June 2015, RCAC Chairs will receive an individual RCAC budget report. A sample report was provided, and reviewed by the Committee. Ms. Ferrer encouraged Committee members to review the sample report and provide comments and suggestions. Mr. Prampetch noted that member stipends, transportation, and reimbursement expenses will increase in April due to the scheduled RCAC conference. Board member Pérez inquired about the amount of last fiscal year’s budget compared to this year’s budget amount. Ms. Ferrer informed that the budget is based on prior history, and explained that the Finance Department takes the prior budget as a starting point. Staff reviews to make recommendations on areas that need increased funding. Board Member Pérez requested staff to follow up on the amount of last year’s budget. Board Member Pérez and Ms. Ferrer reminded members to provide input in regard to budgeting in advance for activities that intertwine with L.A. Care’s mission, and are of benefit to the members and the community. Executive Community Advisory Committee April 8, 2015 APPROVED 129 AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION ITEM/PRESENTER TAKEN Carlos Aguirre, RCAC 2 Chair asked for clarification if RCAC and CCI budgets are combined, and if the RCACs’ budget has increased from prior years. Mr. Prampetch informed that the expense report provided includes spending for the CCI Councils. Ms. Ferrer requested that a breakdown of CCI Council spending be included in future reports. Ms. Savage Pinkney noted that promotional items spending incurred in the first quarter does not necessarily mean that the items have already been distributed in the community, and added that purchased items can be used in the second or third quarter. She also noted that an area for potential funding increase would be “rent” due to the increased services in additional areas. Ms. Ferrer informed that promotional items are purchased in bulk to obtain better pricing. In regard to suggestion related to increasing budget towards rent, Ms. Ferrer noted that expansion of this budget item need be considered due to the fact that 54% has already been spent in the first quarter. She noted that rent includes RCAC meeting sites, and conference site. Ms. Savage Pinkney asked for clarification on reimbursements. Mr. Prampetch informed that reimbursements include child care expenses and mileage for attending RCAC and ECAC meetings. PUBLIC COMMENT Ms. Cooper noted that the Ambassadors do more than just recruitment. She shared concerns about the lack of budget and staffing for this program and asked if the program has been terminated as she has not received a formal notice of such action. She acknowledged the increasing membership in the CCI Councils, and noted that any concerns related to the budget be forwarded to Board Member López, with a request to report back to the Committee. Ms. Cooper also shared concerns in regard to the CCI Council budget and staffing. Board Member Pérez requested that a letter be sent to the RCAC Ambassadors notifying them of the reasoning behind the closure of the program, and next steps. Ms. Eakins reminded Committee members that at the March meeting it was decided to dissolve the Ambassador program, and make recruitment priorities inclusive to all RCAC members with diligent support from staff. Ms. Eakins noted the need for additional and continued education at each RCAC meeting to develop strong and effective outreach efforts. Ms. Cooper noted her objection to the comments and reasoning however welcomed additional training. Ms. Cooper asked for additional funding for the CCI, RCACs and CO&E field staff. She acknowledged staff and requested these issues be addressed. Ms. Ferrer acknowledged Ms. Cooper’s concerns, and informed that there is a budget to support the work of the CCI and RCAC Field Specialists and Liaisons. Ms. Ferrer added that there is a budget for the CCI Councils, and reiterated that a separate line item for the CCI Council budget will be presented at the next meeting.
Executive Community Advisory Committee April 8, 2015 APPROVED 130 AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION ITEM/PRESENTER TAKEN In regard to recruitment, Board Member Pérez requested staff to consider allowing more spaces in the RCACs be occupied by Medi-Cal recipients to help fulfill the current vacancies throughout the RCACs. She noted that the CCI Councils offer a possibility for Seniors and People with Disabilities to join and advisory Council. Ms. Eakins informed that RCAC work plan includes the opportunity to attend community meetings and events to present, and distribute information about L.A. Care and to offer an opportunity to join the RCACs and CCI Councils. She noted the importance of actively collaborating with the assigned Field Specialist to promote the RCACs within the community. Board Member López informed the Committee that the goal of the consumer member representatives on the Board is to empower the RCACs to take ownership and manage their respective budgets throughout the year. He reminded Committee members that L.A. Care allocates a certain amount of funds to invest in the community through ECAC and RCACs. He reiterated the importance of maximizing the funds available in the budget, and encouraged Committee members to forward ideas and suggestions specific to the need of each individual RCAC. Carlos Aguirre, RCAC 2 Chair, thanked Board Member López for the time spent at today’s meeting and his advocacy efforts on behalf of the RCACs in relation to the budget. Mr. Aguirre noted concerns related to the Board Members’ new job responsibilities with AltaMed, and inquired about the Board Members’ availability to attend RCAC meetings. Board Member López indicated that he changed employment twice within the past year, and apologized for not attending all RCAC meetings. He assured the Committee of his due diligence in advocating to the Board on behalf of the RCACs. Board Member López noted that significant improvements have been made over the past two years, and offered to discuss in further detail at a future meeting. Board Member López noted that he has been unable to attend RCAC meetings during the first quarter of the year, and mentioned that he last attended a RCAC 2 meeting. He informed the Committee that his intent is to visit the RCACs and will be able to do so moving forward. AT-LARGE MEMBER Demetria Saffore, and Silvia Poz, At-Large Members, reported (a copy of the reports can be requested by UPDATE contacting CO&E): (MEMBER The first CCI consumer Council meeting for Area 2-San Fernando Valley took place on March 25, RECRUITMENT/CCI) 2015 from 10:00 a.m. to 12:30 p.m. CCI Council members received an overview and identified expectations for the Council and Council members. There was a learning session from guest speaker Denny Chan from Justice in Aging about the current CCI status in Los Angeles County. Council members received a flyer for the upcoming spring conference, and were encouraged to attend. Council members discussed CCI Area 2 meeting schedules, and unanimously agreed to meet on the 4th Wednesday of every other month from 10:00 a.m. to 12:30 p.m. The meeting was Executive Community Advisory Committee April 8, 2015 APPROVED 131 AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION ITEM/PRESENTER TAKEN attended by one CCI Council Area 1 member, and five CCI Council Area 2 members. Additionally, seven members of the public were present. Three applications for CCI Council Area 2 membership were received at this meeting. Jerry Edmond, CCI Field Specialist, CCI Areas 1 and 3 reported: CCI Council Area 1 CCI field staff visited a couple of senior centers in Palmdale and Lancaster, to meet with Directors and discuss ways to identify seniors that are currently enrolled in L.A. Care. There is one CCI Council member in Area 1. It is expected that more applications will be received by the end of the month. On April 21, L.A Care staff will participate in a resource fair to be held at Antelope Valley Senior Center in an effort to recruit members for CCI Council Area 1. CCI Council Area 3 CCI field staff including Nancy Molina, CCI Liaison, visited multiple senior centers in CCI Council Area 3. There are 10 CCI Council members in Area 3. On April 10, 2015 staff is scheduled to visit Ladera Heights Senior Center to outreach to approximately 60 seniors. Board Member Pérez inquired about the maximum membership allowed per CCI Council and asked if there is a deadline to fulfill CCI Council membership. Mr. Edmond informed that each CCI Council can have up to 11 members, and noted that currently CCI Council Areas 1 and 2, and 3 and 4 hold joint meetings due to low membership, and to maximize available resources. He indicated that the intent is to recruit members to each CCI Council, and be able to hold meetings in each of the four Council areas by early May. Board Member Pérez requested that a yearly schedule of CCI Council meetings be provided to the Committee. Susan Ma, CCI Field Specialist, CCI Area 2 and 4,reported: CCI Council Area 2 On April 7, 2015, staff is scheduled to attend a Consumer Advisory Committee meeting at North Los Angeles Regional Center. Staff will contact Las Palmas Senior Center in San Fernando to schedule a presentation. CCI Council Area 4 There are two Council members currently enrolled in CCI Area 4. Staff recruitment activities include the following:
Executive Community Advisory Committee April 8, 2015 APPROVED 132 AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION ITEM/PRESENTER TAKEN Visit to the Citizen’s Advisory Commission on Disabilities on March 12, 2015, Visit to the Long Beach Senior Center, California Senior Center, Cesar E. Chavez Park Community Center, and Silverado Park Community Center. Future meetings and presentations in Area 4 include: Disabled Resource Center (one of six independent living centers in Los Angeles County). CCI presentation at Silverado Park Community Center on April 20. CCI Presentation at California Recreation Community Center on April 29. On April 15, CCI staff will provide a presentation to a Cambodian group at California Recreation Center in conjunction with L.A. Care Health Promoters who will be teaching about nutrition. As of February 2015 CCI staff began collaborating with the Member Outreach Retention and Engagement (MORE) team to help identify potential CCI Council members. Since then, CCI staff has received between four and five referrals per week, and in the month of March a total of 14 referrals were received. Staff is currently following up on the referrals, of which two have been identified as potential Council Area 3 members. An invitation has been extended to these two potential members to attend the next meeting on April 22, 2015. Ms. Savage Pinkney asked if the senior center meetings attended by CCI staff are already established meetings, and about the best approach to deliver an appropriate message to people who want to join a health plan but do not know how to select a provider. Ms. Ma suggested that individuals who are interested in joining a health plan be referred to Health Care Options (HCO) or the Health Insurance Counseling and Advocacy Program (HICAP) to receive unbiased information on benefits and health plans. Ms. Eakins informed the Committee about strict regulations that only allow L.A. Care to provide general and unbiased information so that the person is able to make their best informed decision.
Ms. Poz reported that there is one candidate for RCAC membership approval. She reviewed the membership attachment (Attachment can be requested through the CO&E department). Six interest cards were received in March 2015 from RCACs 3, 7, and 8. A total of 319 interest cards have been received to date. Not all interest cards are processed due to lack of eligibility, or because L.A. Care is looking for specific product lines to reflect the overall L.A. Care membership. Fifty three new members have joined the RCACs since membership reopened.
COMMUNITY Chairperson Sevilla informed that the Pomona Unified School District will host a parent
Executive Community Advisory Committee April 8, 2015 APPROVED 133 AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION ITEM/PRESENTER TAKEN ENGAGEMENT conference, followed by a college and career fair on Tuesday, April 14, 2015. The conference will be from 8:30 a.m. to noon, exhibits and parent resources will be available from 4:00-5:30 p.m. Ms. Saffore informed of the “New Eyes for the Needy”- Eyeglass voucher program. She encouraged everyone to call 973-376-4903 for more information. Dalia Cadena, RCAC 7 Chair, inquired about L.A. Care’s participation at an upcoming three day festival in Huntington Park. Ms. Chitica asked for contact information for the festival’s organizer to follow up on space availability for a resource table. Christina Deh-Lee informed that RCAC 9 will host a resource table at a Cambodian New Year Celebration. The event will take place on April 25 at El Dorado Park located at 7550 Spring Street Long Beach, CA. Ms. Deh-Lee noted that there will be a $30.00 pre-sale admission fee per vehicle which will increase to $40.00 on the day of the event. The event will have traditional Cambodian ceremonies and modern performances, a live band with famous Cambodian singers, carnival games, slides, and face painting, merchandise and resource booths as well as exotic food booths. Ms. Deh-Lee also informed about a three mile street fair in Long Beach. The event is scheduled for June 6, 2015, and asked staff if possible for L.A. Care and RCAC 9 to participate, and have a resource booth at this event. She will contact staff to provide additional information. MEMBER ISSUES Mr. Aguirre reported an individual member issue that was received at the February 23, 2015 RCAC 2 RCAC 2 meeting. The member submitting the concern reported access issues with San Fernando Interdisciplinary Team Clinic. Member stated that she had no choice but to take her child to Olive View Hospital (IDT) emergency room due to high fever and throat infection, after multiple unsuccessful phone calls to the clinic. The clinic acknowledged the lack of front desk personnel to answer phone calls. Member expressed concerns about the lack of access to the clinic, and potential unnecessary over use of emergency room visits when child is sick. In response to clarification question from Ms. Eakins regarding the issue report date on the above case, Judy Hsieh Bigman, Resource Specialist, indicated that although the issue was reported at the February 23, 2015 RCAC 2 meeting, additional information was required before the issue could be presented to ECAC. Ms. Eakins requested that a reference be added to future reports to justify if there is a delay for presenting the issue to the Committee. Mike Shook, Director, Quality Improvement, acknowledged receipt of the case referenced above and informed that this will be reviewed by the IDT during their regularly scheduled meeting tomorrow. This issue will most likely be handled through a grievance process.
Executive Community Advisory Committee April 8, 2015 APPROVED 134 AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION ITEM/PRESENTER TAKEN Mr. Shook provided the following status update regarding issues that were pending from last month’s ECAC meeting, in addition to the ones submitted by ECAC last month: Issue submitted by RCAC 8 in regard to private and community clinics in RCAC region 8 not accepting new Medi-Cal patients unless they had prior history with the clinics. Upon investigation of this issue, the IDT identified that the Wilmington Health Center (Broad Clinic) had closed panels and weren’t accepting new members due to the transition of paper charts to electronic health records. As of February 2015 panels have reopened with the exception of one provider whose ratio is currently higher than allowed by the state. This issue has been resolved however, Mr. Shook asked Committee members to forward any further issues to their assigned Field Specialist as well the Member Services Department. Issue reported by RCAC 11 in regard to quality of service and priority to cash paying patients, discrimination and service charges to members with Medi-Cal. The IDT investigated the case and identified issues with Culture and Linguistic Services. The Provider Network Operations (PNO) and Cultural and Linguistics Departments are drafting a letter to be sent to Pomona Valley Hospital and various clinics in the Pomona area, the purpose of the letter is to inform the providers on how to access interpreter services. Ms. Ferrer asked that a copy of the correspondence be brought back to the ECAC along with the status update. Issue reported by RCAC 7 in regard to unacceptable sanitary conditions at La Libertad Medical Clinic and All Care Medical Group. A site review was conducted in the past for All Care Medical Group with a passing score. On February 27, the Facility Site Review (FSR) Department conducted an unannounced focused reviewed walk-through of Pediatric, Family Practice, Internal Medicine, and Lab areas on the second and third floors, and looked at cleanliness and infection control. Every unit was surveyed and staff questioned regarding access, safety, and infection control criteria. Staff acknowledged that this site has processes in place to ensure that the facility is clean. At the time of the unannounced visit the FSR found that the facility was clean, neat, and well maintained. In regard to La Libertad Medical Clinic, Mr. Shook informed the Committee that this is clinic is not contracted with L.A. Care thus the FSR Department can’t conduct a site visit. Ms. Ferrer requested that the results of the unannounced site visit be presented at the next meeting. Issue reported by RCAC 6 in regard to prolonged wait time at Saint Francis Medical Center’s urgent care. The issue was investigated, and on March 4, 2015, the PNO Department was informed that St. Francis only has an emergency room and not an urgent care center. Mr. Shook reminded members that emergency rooms and urgent care centers triage the member’s condition and those people with a life threatening condition are treated first.- Issue presented by RCAC 11 in regard to prolonged wait time at East Valley Health Centers in West Covina and Pomona, including for those with previously scheduled appointments,
Executive Community Advisory Committee April 8, 2015 APPROVED 135 AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION ITEM/PRESENTER TAKEN delayed authorization process to see a specialist., and lack of follow up. L.A. Care’s most recent site reviews for the East Valley Health Center West Covina, and Pomona locations occurred on September 25, 2015 and May 29, 2014 respectively. At that time, both locations received corrective action plans which identified referral process problems and lack of chart documentation regarding member follow up and follow through on referrals. Each site addressed the deficiencies noted in their corrective action plans however there is opportunity for L.A. Care to monitor the progress and educate providers and staff. L.A. Care’s PNO Department to reach out to these facilities and get an update on their progress. Issue presented by RCAC 1 in regard to concerns related to appointment making process at the South Valley Health Center. The South Valley Health Center is a county facility, and thus the IDT has engaged staff from the Safety Net Initiatives Department who is currently investigating this concern as they work directly with DHS sites or county facilities. A report on the resolution of this issue will be provided at the May ECAC meeting. Issue presented by RCAC 1 in regard to difficulty obtaining a specialist referral from primary care physician. Additional information regarding this case was received two weeks ago, and this will be discussed at tomorrow’s IDT team meeting. It is desired that a final report on this issue be provided at the next meeting. Issue presented by RCAC 2 in regard to lack of cultural competency and sensitivity at North West Valley Health Corporation and Wellness Center. The issue relates to concerns about providers’ gender, and reproductive health and gynecological issues with young women. Members asked if L.A. Care has compliance guidelines around cultural competency and sensitivity, and if L.A. Care offers provider training sessions related to cultural competency and sensitivity. Staff received information about the clinic, and is investigating if the issue reported involves an isolated provider or if this is an overall clinic issue. Mr. Shook noted the need for additional information from the member who submitted the concern to further investigate the issue. The assigned Field Specialist in RCAC 2 was requested to follow up and gather more information on this case. Mr. Shook reiterated the importance of tracking trends and handling this as a grievance if this involves a specific member and provider. Issue presented by RCAC 3 in regard to lack of Urgent Care facilities in the Pasadena area. Mr. Shook informed the Committee that there are four Urgent Care Centers in the area which are affiliated with different participating provider groups. Mr. Shook noted that L.A. Care is geo-mapping the area to identify available resources, and has identified opportunities of adding specific services to this area. Currently PNO has gathered a list of existing Urgent Care Centers in Los Angeles County, and L.A. Care will share the list with the Nurse Advise Line for them to be able to refer members when needed. Mr. Shook reminded Committee members that staff is working on the development of a policy Executive Community Advisory Committee April 8, 2015 APPROVED 136 AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION ITEM/PRESENTER TAKEN and procedure, and will share this document with the Committee once it becomes available. Board Member López requested that a process chart be included in the policy and procedure. Board Member López asked if there is an established timeframe to solve issues that are presented to the IDT. Mr. Shook reminded the Committee that at a prior meeting, it was unanimously agreed upon by Committee members that staff would provide an update on the issue within 30 days, and a final resolution would be provided within 60 days from receipt of all necessary documentation. Ms. Ferrer noted the need to gather complete data related to the issue in order to allow staff to begin the investigation. Ms. Eakins added that Field Staff will receive further training to transfer individual issues to the Member Services Grievance Department for immediate follow up. Board Member López requested if possible to have a stop light report to list by color those issues that have been resolved (green), those in progress (yellow) and those that have been recently received (red). He noted that once this report is reviewed and approved by ECAC it can be shared at the Board of Governors meeting. Staff will work on this request and will bring a draft for Committee members’ review at the May meeting. Ana Romo, RCAC 8 Chair, and Ms. Deh-Lee acknowledged process improvements of the IDT, and the viable results to the issues that are being submitted. Board Member Pérez requested that a presentation from the IDT team be scheduled at a future Board meeting. She asked that the presentation highlights progress, and difference made towards solving member issues. Ms. Ferrer acknowledged the request, and noted the need to work with Board Services to get item on a future meeting Agenda. Ms. Deh-Lee asked for an update on the possibility to develop a confidentiality waiver. Mr. Shook informed about conversations held with L.A. Care’s Legal, and Regulatory Affairs and Compliance Departments around this request. He noted that this request needs to be carefully reviewed by those Departments and may be a lengthy process. He reminded the Committee that L.A. Care is required by law to protect members’ confidentiality. Lidia Parra, RCAC 3 Chair, informed that CVS pharmacy continues to refer L.A. Care members to other pharmacies in order to get their prescriptions filled. Ms. Ferrer informed that L.A. Care’s Pharmacy Department confirmed that CVS is a contracted pharmacy with L.A. Care. She requested that additional information be gathered in regard to the specific CVS pharmacy involved in this issue, and that the concern be documented for appropriate follow up. PUBLIC COMMENT: An unidentified member of the public shared concerns about a community clinic refusing urgent
Executive Community Advisory Committee April 8, 2015 APPROVED 137 AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION ITEM/PRESENTER TAKEN medical care to her son because they only work with appointments and do not accept walk-ins. She noted that the clinic’s appointment system is not efficient, and members are usually asked to wait an entire month or year to get an appointment for a physical exam. Staff from the Member Services Department present at today’s meeting will document the concern and conduct an appropriate follow up. OLD BUSINESS RCAC SPRING Ms. Hsieh Bigman reported: CONFERENCE The RCAC spring conference is scheduled on April 30, 2015 from 8:00 a.m. to 3:00 p.m. at the Cathedral of Our Lady of Angels in Downtown Los Angeles. The Agenda will include internal and external guest speakers such as Susie Baldwin, MD, MPH, Chief, Health Assessment Unit, Office of Health Assessment and Epidemiology, Los Angeles County Department of Public Health, who will be presenting on key indicators of health throughout L.A. County. RCAC members will have an opportunity to discuss key indicators of health, how they affect individual RCAC regions, and what RCAC members can do to help advocate within L.A. Care and other organizations There will also be a behavioral health panel discussion to provide information on behavioral health benefits and how to access them. Flyers and save the date postcards were sent in the mail, and members have had an opportunity to confirm their attendance. Staff is identifying bus pick up locations and times. Ms. Chitica informed that L.A. Care will not provide bus transportation to RCAC 4 members because the event is within the RCAC 4 area. Ms. Hsieh Bigman noted that L.A. Care will reimburse mileage and validate parking for those members who choose to drive to the conference. Resource tables will be available, to include staff from L.A. Care’s Pharmacy Department, who will be providing general information, additionally, they will be available to do medication reconciliation with those members who bring the medications they are currently taking. The Pharmacist will be able to provide individual assistance to review medications and give a summary to the member, as well as answer any questions. Committee members were asked to inform their RCAC members about this added service. Romalda Meza, RCAC 5 Chair, asked if guests are welcomed to attend. Ms. Hsieh Bigman informed that this conference is only for L.A. Care RCAC, CCI Council members, and Health Promoters. Ms. Chitica reminded the Committee that children should not be brought to the conference unless they are breastfeeding.
Executive Community Advisory Committee April 8, 2015 APPROVED 138 AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION ITEM/PRESENTER TAKEN ECAC AD HOC Ms. Chitica reminded Committee members that the ad hoc Committee will meet again COMMITTEE BOG immediately after the regularly scheduled ECAC meeting on May 13. Mr. Aguirre, Ms. Saffore, ELECTIONS Ms. Poz, and Ms. Romo are scheduled to attend. Ms. Chitica noted that these members volunteered to be part of the ad hoc Committee during the December 2014 ECAC meeting. She informed Committee members that having more than seven members in attendance at an ad hoc Committee would constitute having a regular meeting. Ms. Chitica further noted that the task of the ad hoc is to discuss ideas and recommendations to improve the election process. Those ideas and recommendations made by the ad hoc will be presented to ECAC for review, discussion, and approval. Ms. Eakins noted the possibility for RCAC members to forward their ideas to their respective RCAC Chair, who in turn can forward the information to the ad hoc Committee. PUBLIC COMMENT: Ms. Cooper asked if the ad hoc Committee meetings are open to the public. Ms. Chitica will verify information with Board Services, and will provide an update at a future meeting. Ms. Cooper expressed concerns about the election process and noted that she would like to ensure that the process is fair. She further noted interest in knowing who will be eligible to vote at the elections (CCI, members, RCAC members, L.A. Care members). She indicated that it is important to include parents and representatives of those L.A. Care members that aren’t able to articulate before ECAC makes final comments regarding the election process. Ms. Cooper requested answers to her questions and concerns. Board Member Pérez requested minutes for the last ad hoc Committee meeting and that a response is brought back to ECAC in regard to the possibility of opening the ad hoc Committee to members of the public. ECAC LEADERSHIP Ms. Chitica informed that the next ECAC leadership training is scheduled for Tuesday, April 28, TRAINING 2015 from 8:30 a.m. to 3:00 p.m. at L.A Care head quarter offices. Ms. Chitica reminded Committee members that these training sessions are mandatory for Chairs, Vice Chairs and At Large members. PUBLIC COMMENTS Ms. Kuo Fan announced that L.A. Care’s Behavioral Health Services Department will be hosting a Palliative Care Symposium on April 11, 2015 from 8:30 a.m. to 3:00 p.m. at the Glendale Hilton. Members are invited to attend the symposium to engage in conversations with providers about major illnesses and end of life issues. Transportation and interpretation services will be available for those members who register today (Flyers were available for those interested in attending).
Executive Community Advisory Committee April 8, 2015 APPROVED 139 AGENDA MOTIONS / MAJOR DISCUSSIONS ACTION ITEM/PRESENTER TAKEN Nancy Molina was introduced as the new CCI Liaison that will be working with Ms. Ma and Mr. Edmond. Ms. Savage Pinkney announced that Assembly Member Sebastian Ridley Thomas is inviting members of the 4th and 5th District to participate in a legislative breakfast and informational hearing on Friday, April 10, 2015 at the California African American Museum in Exposition Park. This is a free event that will provide opportunities to hear discussions from service providers, state and county agencies, on issues related to autism and mental health disorder in communities of color. Interested individuals can register by calling 310-342-1070. Ms. Cooper noted the need for L.A. Care to conduct additional outreach and education around cultural diversity. She noted the high infant mortality rate amongst African American. Ms. Cooper acknowledged the Long Term Care Department staff which assisted her in a courteous and professional manner, and also acknowledged CO&E staff. She asked Board members López and Pérez to advocate for funding for the CO&E Department, CCI Councils and RCACs. ADJOURNMENT Chairperson Sevilla adjourned the meeting at 1:15 p.m.
RESPECTFULLY SUBMITTED BY: APPROVED BY:
Hilda Stuart, Committee Liaison, Board Services ______Linda Merkens, Manager, Board Services Elda Sevilla, ECAC Chair Date ______
Executive Community Advisory Committee April 8, 2015 APPROVED 140 L.A. Care Legislative Matrix Updated as of May 18, 2015
The following matrix includes legislation currently being tracked by L.A. Care’s Government Affairs Department. This list does not include all bills currently being monitored; instead, this is a shortened list Government Affairs believes should be flagged for your attention. If there are any questions, please contact Cherie Fields, at [email protected] or by or by telephone at (916) 930-0043.
AB 11 AUTHOR: Gonzalez [D] TITLE: Employment: Paid Sick Days: In-Home Supportive Services SUMMARY: Revises the definition of an employee under the Healthy workplaces, Healthy Families Act of 2014 to include providers of in home support services. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee – Suspense File
AB 50 AUTHOR: Mullin [D] TITLE: Medi-Cal: Nurse Home Visiting Programs SUMMARY: Requires the State Department of Public Health to develop a grant application and award grants to counties for other evidenced-based home visiting program. Requires the Department to develop and implement a plan to ensure that Nurse-Family Partnership and other evidenced-based nursing home visiting programs are offered and provided to Medi-Cal eligible pregnant women. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee
AB 68 AUTHOR: Waldron [R] TITLE: Medi-Cal SUMMARY: Creates the Patient Access to Prescribed Epilepsy Treatments Act. Requires any drug in the seizure and epilepsy therapeutic class would be a Medi-Cal covered benefit. Requires a managed care plan to provide coverage regardless of whether the drug is on the plan's formulary, if the provider demonstrates the necessity, not on the Medi-Cal managed care plan formulary, and consistent with specified federal rules, under which the beneficiary is entitled to an urgent appeal. To read the current text of the bill, click here. POSITION: Watch, CAHP – Oppose SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee
AB 72 AUTHOR: Bonta [D] TITLE: Medi-Cal: Demonstration Project SUMMARY: Requires the State Department of Health Care Services to submit an application to the federal Centers for Medicare and Medicaid Services for a waiver to implement a demonstration project that, among other things, continues the state's momentum and successes in innovation achieved under the demonstration project for better care coordination for seniors and persons with disabilities. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Senate Health Committee
AB 73 AUTHOR: Waldron [R] TITLE: Medi-Cal Benefits: Prescription Drugs SUMMARY: Provides, to the extent permitted by federal law, that drugs in specified therapeutic drug classes that are prescribed by a Medi-Cal beneficiary's treating provider are covered benefits. Requires that a Medi-Cal managed care plan cover the if the treating provider demonstrates that the drug is medically necessary, not on a Medi-Cal managed care plan formulary, and consistent with federal rules and regulations for labeling and use, under which circumstance the beneficiary would be entitled to appeal. To read the current text of the bill, click here. POSITION: Watch, CAHP – Oppose SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee
141 AB 97 AUTHOR: Weber [D] TITLE: In-Home Supportive Services SUMMARY: Requires the State Department of Social Services to program its Case Management Information and Payroll System to be able to receive payments from managed care health plans for additional personal care service and related domestic service hours, to issue a single payroll check to providers, and to differentiate between the two types of authorized hours. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee
AB 159 AUTHOR: Calderon [D] TITLE: Investigational Drugs, Products, and Devices SUMMARY: Permits a manufacturer of an investigational drug, biological product, or device to make the product available to eligible patients with a serious or life-threatening disease or condition. Authorizes a health benefit plan to provide coverage for such products made available pursuant to these provisions. Prohibits disciplinary action for any product or drug recommendation if consistent with a certain protocol. Prohibits altering a provider's Medicare of Medicaid participation due to an access recommendation. To read the current text of the bill, click here. POSITION: Watch, CAHP – Watch SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee
AB 187 AUTHOR: Bonta [D] TITLE: Children’s Services Program: Medi-Cal: Managed Care SUMMARY: Extends the termination of the prohibition against the State Children's Services Program from being incorporated into a Medi-Cal managed care contract entered into after a specified date, until the State Department of Health Care Services has completed evaluations of specified pilot programs created as part of a specified demonstration. To read the current text of the bill, click here. POSITION: Watch; CAHP – Watch SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee – Suspense File
AB 211 AUTHOR: Gomez [D] TITLE: In-Home Supportive Services SUMMARY: Modifies the definition of the Coordinate Care Initiative for the purposes of determining which provisions become inoperative if the condition is not met, and excludes, among others, those provisions that establish the In-Home Supportive Services Employer-Employee Relations Act. Establishes the Statewide Authority and determines the duties of, and when those duties are assumed by, the Authority. Establishes the IHSS Fund. Requires counties to pay the County IHSS Maintenance of Effort. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee – Suspense File
AB 294 AUTHOR: Lackey [R] TITLE: Health and Human Services: State Plans: Waivers SUMMARY: Requires a department within the Health and Human Services Agency that has received approval of an operational state plan by a federal agency, or that has applied and has been approved for a waiver from a federal law or regulation, to make any and all approved plans or waiver applications available to the public by publishing that information on the home page of the department's Internet Web site. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Senate
AB 339 AUTHOR: Gordon [D] TITLE: Health Care Coverage: Outpatient Prescription Drugs SUMMARY: Requires health care service plan contract or a health insurance policy providing coverage for outpatient prescription drugs, to provide coverage for medically necessary prescription drugs, including those for which there is not a therapeutic equivalent. Requires copayments, coinsurance, and other cost sharing to be reasonable. Provides the formula for a specified supply. Requires coverage for single-tablet and extended release regiments, unless certain conditions apply. Relates to higher tier placement. To read the current text of the bill, click here. POSITION: Watch, CAHP – Oppose SPONSOR: N/A
142 DISPOSITION: Assembly Appropriations Committee
AB 366 AUTHOR: Bonta [D] TITLE: Medi-Cal: Reimbursement: Provider Rates SUMMARY: Amends existing law that establishes the Medi-Cal program. Requires claims for payments pursuant to the inpatient hospital reimbursement methodology to be increased for the 2015-16 fiscal year. Requires the State Department of Health Care Services to increase each diagnosis-related group payment amount based on increases in the medical component of the Consumer Price Index. Relates to reimbursement reductions and managed care plan rate range increases. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee
AB 374 AUTHOR: Nazarian[D] TITLE: Health Care Coverage: Prescription Drugs SUMMARY: Prohibits a health care service plan or health insurer that provides medication pursuant to a step therapy or fail-first requirement from applying that requirement to a patient who has made a step therapy override determination request if, in the professional judgment of the prescribing physician, the step therapy or fail- first requirement would be medically inappropriate for that patient for specified reasons. To read the current text of the bill, click here. POSITION: Watch; CAHP - Oppose SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee
AB 461 AUTHOR: Mullin [D] TITLE: Coordinated Care Initiative SUMMARY: Authorizes a Medi-Cal beneficiary receiving services through a regional center who resides in the County of San Mateo to participate voluntarily in a demonstration project that enables beneficiaries dually eligible for the Medi-Cal program and the Medicare Program to receive a continuum of services that maximizes access to, and coordination of, benefits between the programs. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Assembly
AB 533 AUTHOR: Bonta [D] TITLE: Health Care Coverage: Out-of-Network Coverage SUMMARY: Requires a health care service plan contract or health insurance policy to provide that if an enrollee or insured obtains care from a contracting health facility, at which, or as a result of which, the enrollee receives covered services provided by a nonparticipating provider, the enrollee or insured is required to pay such provider only the same cost sharing required if the services were provided by a contracting individual health professional. Prohibits owning a nonparticipating provider more. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee
AB 623 AUTHOR: Wood [D] TITLE: Abuse-Deterrent Opioid Analgesic Drug Products SUMMARY: Prohibits, where an abuse-deterrent opioid analgesic drug product is available, a health care service plan or insurer from requiring the use of opioid analgesic drug products without the abuse-deterrent properties in order to access such opioid analgesic drug products. Require such plan or insurer to allow a provider to prescribe, and if otherwise covered, to provide coverage for, a less than certain supply of the opioid analgesic drug product. Requires informing the patient on proper storage and disposal. To read the current text of the bill, click here. POSITION: Watch; CAHP – Oppose SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee
AB 627 AUTHOR: Gomez [D] TITLE: Audits of Pharmacy Benefits SUMMARY: Makes nonsubstantive changes to existing law that imposes specified requirements on an audit of pharmacy services provided to beneficiaries of a health benefit plan and provides that those requirements do not apply to an audit conducted because a pharmacy benefit manager, carrier, health benefit plan sponsor, or other 3rd-party payer has indications that support a reasonable suspicion that criminal wrongdoing, willful misrepresentation has occurred. To read the current text of the bill, click here.
143 POSITION: Watch; CAHP – Watch SPONSOR: N/A DISPOSITION: Senate
AB 635 AUTHOR: Atkins [D] TITLE: Medical Interpretation Services SUMMARY: Requires the State Department of Health Care Services to seek federal funding to establish a program to provide and reimburse for certified medical interpretation services except sign language interpretation services, to Medi-Cal beneficiaries who are limited English proficient. Offers medical interpreter services to Medi-Cal providers serving beneficiaries on either a fee-for-service or managed care basis. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee – Suspense File
AB 648 AUTHOR: Low [D] TITLE: Community-Based Services: Virtual Dental Home SUMMARY: Establishes the Virtual Dental Home program to expand the virtual dental home model of community-based delivery of dental care to the residents of this state who are in greatest need. Authorizes the program administrator to encourage development and expansion of the delivery of dental health services in community clinics and school programs. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee – Suspense File
AB 690 AUTHOR: Wood [D] TITLE: Medi-Cal: Federally Qualified Health Centers SUMMARY: Includes a marriage and family therapist within those health care professionals under the Medi-Cal program. To read the current text of the bill, click here. POSITION: Watch SPONSOR: CPCA DISPOSITION: Assembly Appropriations Committee – Suspense File
AB 796 AUTHOR: Nazarian[D] TITLE: Health Care Coverage: Autism: Pervasive Disorders SUMMARY: Expands eligibility for person to be qualified autism service professional to include those who possess a bachelor of arts or science degree, a registered psychological assistant, a registered psychologist, or an associate clinical social worker. Expands eligibility to qualify as autism service paraprofessional to include person with high school diploma or equivalent and related work experience. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Assembly Business and Professions Committee
AB 845 AUTHOR: Cooley [D] TITLE: Health Care Coverage: Vision Ware SUMMARY: Authorizes the executive board that governs the Health Benefit Exchange to construct, manage, and maintain an Internet Web site that is separate and clearly distinct from the Exchange's internet Web Site, to inform consumers about participating individual and employer-based vision plans that are available to qualified individuals and qualified employers. Requires the Web site to provide an option for consumers to learn more about, and enrollment in, a vision plan through a licensed agent. To read the current text of the bill, click here. POSITION: Watch; CAHP – Watch SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee – Suspense File
AB 858 AUTHOR: Wood [D] TITLE: Medi-Cal: Federally Qualified Health Centers SUMMARY: Relates to the Medi-Cal program and visits. Relates to federally qualified health center services and rural health clinic services. Provides that a maximum of visits taking place on the same day at a single location shall be reimbursed when either after the first visit the patient suffers illness or injury requiring additional diagnosis or treatment or the patient has a medical visit and another health visit or both. Updates provisions regarding per-visit rates and billings. To read the current text of the bill, click here.
144 POSITION: Support, CAHP – Watch SPONSOR: CPCA DISPOSITION: Assembly Appropriations Committee – Suspense File
AB 859 AUTHOR: Medina[D] TITLE: Medi-Cal: Obesity Treatment Plans SUMMARY: Requires the creation of an Obesity Treatment Action Plan to diagnose, treat, and reduce the incidence of adult obesity in the Medi-Cal program. Requires a report on the plan to the Legislature. Requires the plan to include evidence-based principles and obesity treatment guidelines, a plan for identifying and screening patients for obesity, and a review of coverage services to treat obesity. Limits plan application to Medi-Cal fee-for-service plans. Requires seeking federal approvals and participation. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee
AB 1018 AUTHOR: Cooper [D] TITLE: Medi-Cal: Early and Periodic Screening and Diagnosis SUMMARY: Requires to permit county mental health plans to contract with local educational agencies (LEAs) to provide services for Medi-Cal eligible pupils under Early and Periodic Screening, Diagnosis, and Treatment program. Requires the State Department of Health Care Services to permit an LEA to make claims for federal financial participation directly to the Department. Requires the Department to examine methodologies for increasing LEA participation in the Medi-Cal program to help LEAs meet health care needs. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee – Suspense File
AB 1102 AUTHOR: Santiago [D] TITLE: Health Care Coverage: Special Enrollment Periods SUMMARY: Requires certain health care service plans to authorize and permit an enrollee or subscriber to assign the enrollee or subscriber's right to reimbursement for health care services covered under the plan contract by a noncontracting physician and surgeon who furnishes services. Requires certain disability insurers to pay group insurance benefits to a physician and surgeon rendering health care services to an insured upon obtaining consent of the insured. Requires the provision of an estimate to the insureds. To read the current text of the bill, click here. POSITION: Watch; CAHP – Oppose SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee
AB 1114 AUTHOR: Bonilla [D] TITLE: Health Care Coverage: Eligibility and Enrollment SUMMARY: Amends the Health Care Reform Eligibility, Enrollment, and Retention Planning Act that requires Health and Human Services Agency to establish standardized single, accessible, application forms and related renewal procedures for State health care program. Revises those provisions to include letters, as well as forms and notices developed for purposes of creating the standardized application and renewal process. Defines the nature of these forms, letters, and notices. To read the current text of the bill, click here. POSITION: Watch; CAHP – Watch SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee – Suspense File
AB 1117 AUTHOR: Garcia [D] TITLE: Medi-Cal: Vaccination Rates SUMMARY: Requires the establishment of the Childhood Immunization Quality Improvement Fund. Requires the submission for a waiver for a demonstration project to implement the program. Requires a plan to collect and spend fund moneys, including voluntary contributions for Medi-Cal managed care plans to be used for provider support and reward payments to Medi-Cal managed care plans. Requires contracting with researchers to develop and support an evaluation of effectiveness of the project. To read the current text of the bill, click here. POSITION: Watch; CAHP – Oppose SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee – Suspense File
AB 1162 AUTHOR: Holden [D] TITLE: Medi-Cal: Tobacco Cessation
145 SUMMARY: Provides that tobacco cessation services are covered benefits under the Medi-Cal Program. Requires that those services include unlimited quit attempts and counseling sessions and a treatment regimen of any medication approved by the federal Food and Drug Administration for tobacco cessation. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee
AB 1231 AUTHOR: Wood [D] TITLE: Medi-Cal: Nonmedical Transportation SUMMARY: Adds to the schedule of benefits under the Medi-Cal program nonmedical transportation for a beneficiary to obtain covered specialty care Medi-Cal services, if those services are more than 60 minutes or 30 miles from the beneficiary's place of residence. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee
AB 1261 AUTHOR: Burke [D] TITLE: Community-Based Adult Services: Adult Day Health SUMMARY: Establishes the Community-Based Adult Services program as a Medi-Cal benefit and would specify eligibility requirements for participation in the CBAS program. Requires that CBAS providers be licensed as Adult Day Health Care centers and certified by the California Department of Again as CBAS providers. Requires CBAS providers to meet specified licensing requirements. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee – Suspense File
AB 1305 AUTHOR: Bonta [D] TITLE: Limitations on Cost Sharing: Family Coverage SUMMARY: Relates to the Knox-Keene Health Care Service Plan act of 1975. Requires for family coverage limits on annual out-of-pocket expenses to include a maximum out-of-pocket limit for each individual covered by the plan contract or policy that is less than or equal to the maximum out-of-pocket limit for individual coverage under the plan contract or policy. Requires a family plan deductible to be no more than a deductible on an individual plan contract or policy. To read the current text of the bill, click here. POSITION: Watch; CAHP – Likely Oppose SPONSOR: N/A DISPOSITION: Assembly Appropriations Committee
SB 4 AUTHOR: Lara [D] TITLE: Health Care Coverage: Immigration Status SUMMARY: Relates to the Patient Protection and Affordable Care Act. Provides a waiver to allow individuals who are not eligible to obtain health coverage because of immigration status to obtain coverage from the State Health Benefit Exchange. Provides for the facilitation of enrollment for certain individuals not eligible for Medi-Cal coverage. Requires health care service plans and health insurers to sell a specified product. Creates the State Health Exchange Program for All Californians relative to the exchange. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Senate Appropriations Committee – Suspense File
SB 26 AUTHOR: Hernandez [D] TITLE: Health Care Cost and Quality Database SUMMARY: Requires the Secretary of the State Health and Human Services to contract to administer the State Health Care Cost and Quality Database. Requires the contractor to report a health care entity that fails to comply with specified requirements. Requires all disclosures to comply with State and federal privacy and data security. Prohibits the disclosure of individually identifiable health data. Requires a review committee to develop parameters for establishing and maintaining the database. To read the current text of the bill, click here. POSITION: Watch; CAHP - Watch SPONSOR: N/A DISPOSITION: Senate Appropriations Committee
SB 33 AUTHOR: Hernandez [D] TITLE: Medi-Cal: Estate Recovery SUMMARY: Requires the Department of Health Care Services to make claims only in specified circumstances for those
146 health care services that the State is required to recover under federal law. Defines health care services. Limits any claims to only the real and personal property or other assets the State is required to seek recovery from. Waives a homestead of modest value. Deletes the proportionate share provision and deletes the requirement that the Department make a claim upon the death of the surviving spouse. To read the current text of the bill, click here. POSITION: Support, CAHP – Support SPONSOR: N/A DISPOSITION: Senate Appropriations Committee – Suspense File
SB 36 AUTHOR: Hernandez [D] TITLE: Medi-Cal: Demonstration Project SUMMARY: Requires the State Department of Health Care Services to submit an application to the federal Centers for Medicare and Medicaid Services for a waiver to implement a demonstration project that continues the state's momentum and successes in innovation achieved under the demonstration project described in existing law. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Assembly
SB 43 AUTHOR: Hernandez [D] TITLE: Health Care Coverage: Essential Health Benefits SUMMARY: Prohibits limits on habilitative and rehabilitative services from being combined on health care service plans. Authorizes the Department of Managed Health Care and the Department of Insurance to adopt emergency regulations implementing amendments made to provisions under the federal Patient Protection and Affordable Care Act. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Senate Appropriations Committee
SB 125 AUTHOR: Hernandez [D] TITLE: Health Care Coverage SUMMARY: Extends annual enrollment periods under the federal Patient Protection and Affordable Care Act and the Knox-Keene Health Care Services Plan Act. Requests the University of California to include essential health benefits and the impact of the State Health Benefit Exchange in a specified analysis, and to assess legislation that impacts benefit design, cost sharing, and premiums. Defines small employer. Extends the Health Benefit Review Program and an annual charge on health service plans and insurers. To read the current text of the bill, click here. POSITION: Support, CAHP – Support, LHPC – Support SPONSOR: N/A DISPOSITION: Assembly Health Committee
SB 128 AUTHOR: Wolk [D] TITLE: End of Life SUMMARY: Enacts the End of Life Option Act. Authorizes an adult who meets certain qualifications, and who has been determined by his or her attending physician to be suffering from a terminal disease to make a request for medication for the purpose of ending his or her life. Prohibits a will or other agreement being impacted by such a decision. Prohibits insurance impact by such a decision. Provides civil and criminal immunity. Provides for a crime to alter or forge a request, and a felony for coercion. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Senate Appropriations Committee
SB 137 AUTHOR: Hernandez [D] TITLE: Health Care Coverage: Provider Directories SUMMARY: Requires health care service plans and insurers for services at alternative rates to make a provider directory available on its Internet Web site, including those who accept new patients. Requires a standard provider director template. Provides for a consistent plan to permit agencies to construct multiplan directories. Prohibits requiring information seekers to demonstrate coverage or to provide policy information. Requires notification when a provider is not accepting new patients. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Senate Appropriations Committee – Suspense File
147 SB 147 AUTHOR: Hernandez [D] TITLE: Federally Qualified Health Centers SUMMARY: Requires the Department of Health Services to authorize a pilot project for federally qualified health centers that agree to participate. Requires the determination of the supplemental capitation amount for each aid category to be paid to each principle health plan that contains at least one participating center in its provider network. Relates to the payment of wrap-cap payments by principle health plans. Requires an evaluation of the project by an independent entity and to report to the Legislature. To read the current text of the bill, click here. POSITION: Support, CAHP – Watch, LHPC - Watch SPONSOR: L.A. Care, CPCA, CAPH DISPOSITION: Senate Appropriations Committee – Suspense File
SB 149 AUTHOR: Stone [R] TITLE: Investigational Drugs: Biological Products or Devices SUMMARY: Permits a manufacturer of an investigational drug, biological product, or device to make the product available to eligible patients with a terminal disease and to provide a related report. Provides the Medical Practice Act does not require a health benefit plan or governmental agency to provide coverage for the cost of such products made available under these provisions. Authorizes a health benefit plan to provide coverage for such products. Prohibits action against a physician for making a recommendation. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Senate Appropriations Committee
SB 199 AUTHOR: Hall [D] TITLE: In-Home Supportive Services: Reading Services for Blind SUMMARY: Includes within the definition of supportive services assistance in reading and completing financial and other documents for recipient of services under the In-Home Supportive Services program who is blind. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Senate Appropriations Committee – Suspense File
SB 243 AUTHOR: Hernandez [D] TITLE: Medi-Cal Reimbursement Rates: Provider Rates SUMMARY: Amends existing law that establishes the Medi-Cal program. Requires claims for payments pursuant to the inpatient hospital reimbursement methodology to be increased for the 2015-16 fiscal year. Requires the Department of Health Care Services to increase each diagnosis-related group payment claim amount based on increases in the medical component of the State Consumer Price Index. Relates to reimbursement reductions and managed care plan and fee-for-service rate range increases. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Senate Appropriations Committee
SB 277 AUTHOR: Pan [D] TITLE: Public Health: Vaccinations SUMMARY: Eliminates the exemption from existing specified immunization requirements based upon personal beliefs. Allows an exemption from future requirements deemed appropriate by the State Department of Public Health for either medical reasons or personal beliefs. Exempts pupils in specified programs. Provides a temporary exclusion is only for a child who has been exposed to a specified disease and whose proof status does not show proof of immunization against one of specified diseases. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Senate Appropriations Committee
148 SB 282 AUTHOR: Hernandez [D] TITLE: Health Care Coverage: Prescription Drugs SUMMARY: Authorizes the prescribing provider to additionally use an electronic process developed specifically for transmitting prior authorization information that is consistent with the standardized form and that meets the National Council for Prescription Drug Programs' SCRIPT electronic prior authorization standards. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Senate Appropriations Committee – Suspense File
SB 289 AUTHOR: Mitchell [D] TITLE: Telephonic and Electronic Patient Management Services SUMMARY: Requires a health care service plan or a health insurer to cover telephonic and electronic patient management services provided by a contracting physician or contracting nonphysician health care provider and reimburse those services based on their complexity and time expenditure. Provides that a plan or insurer is not required to reimburse separately for specified telephonic or electronic visits as part of a bundle of reimbursed services. To read the current text of the bill, click here. POSITION: Watch; CAHP - Oppose SPONSOR: N/A DISPOSITION: Senate Appropriations Committee
SB 388 AUTHOR: Mitchell [D] TITLE: Solicitation and Enrollment SUMMARY: Relates to group health and health insurers providing a written summary of benefits and coverage under the Patient Protection and Affordable Care Act. Provides that summary constitutes a vital document and would require a plan or insurer to comply with requirements applicable to those documents. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Senate Appropriations Committee – Suspense File
SB 479 AUTHOR: Bates [R] TITLE: Healing Arts: Behavioral Analysis: Licensing SUMMARY: Revises the membership of the Board of Psychology. Establishes the Behavior Analyst Act. Requires a person to apply for and obtain a license prior to engaging in the practice of behavior analysis. Requires the applicants to meet certain educational and training requirements, and to submit fingerprints for criminal background checks. Provides the related enforcement powers of the Board. Creates a specified advisory committee. Provides misdemeanor penalties for practicing without a license. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Senate Appropriations Committee
SB 492 AUTHOR: Liu[D] TITLE: Coordinated Care Initiative SUMMARY: Requires the State Department of Health Care Services to develop and post on the Department's Internet Web site an educational and informational guide to assist consumers and patients in understanding the rights afforded to them under the Coordinated Care Initiative and how to effectively exercise those rights. Requires the Department to distribute the guide to specified advocacy groups and programs and to all other interest persons upon request. To read the current text of the bill, click here. POSITION: Watch, CAHP – Watch SPONSOR: N/A DISPOSITION: Senate Appropriations Committee
SB 534 AUTHOR: Pan[D] TITLE: Medi-Cal: Ground Emergency Medical Transportation SUMMARY: Relates to Medi-Cal payments for ground emergency medical transportation services. Authorizes the department to provide supplemental reimbursement for the cost of paramedic services at a rate of payment equal to cost. Requires an intergovernmental transfer program in order to increase capitation payments to Medi-Cal managed care plans for covered ground emergency medical transportation services. Permits increased capitation payments to commence for dates of services on or after a specified date. To read the current text of the bill, click here. POSITION: Watch 149 SPONSOR: N/A DISPOSITION: Senate Appropriations Committee
SB 586 AUTHOR: Hernandez [D] TITLE: Children’s Services SUMMARY: Relates to the Children's Services program, which provides medically necessary services required by physically handicapped children whose parents are unable to pay for those services. Exempts certain contracts from existing law which prohibits services covered by CCA from being incorporated into a Medi- Cal managed care contract. Requires the State Department of Health Care Services to contract with one or more Kids Integrated Delivery System networks. Establishes selection criteria. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Senate Appropriations Committee
SB 783 AUTHOR: Mitchell [D] TITLE: Health Care Coverage SUMMARY: Makes technical nonsubstantive changes to requirements under the federal Patient Protection and Affordable Care Act that requires a health insurance issuer issuing health insurance coverage to comply with minimum medical loss ratios, and to provide an annual rebate to each insured if the medical loss ratio of the amount of the revenue expended by the issuer on costs to the total amount of premium revenue is less than a certain percentage. To read the current text of the bill, click here. POSITION: Watch SPONSOR: N/A DISPOSITION: Senate Rules Committee
150
Board of Governors MOTION SUMMARY
Date: June 4, 2015 Motion No. EXE 100.0615
Committee: Executive Chairperson: Thomas Horowitz, D.O.
Issue: Approval for an ad hoc grant to the Nonprofit Finance Fund (NFF) to provide financial technical assistance to Federally Qualified Health Centers (FQHCs) and FQHC look-alikes.
Background: Staff seeks approval to award $225,250 to the Nonprofit Finance Fund (NFF) to provide financial technical assistance to 25 Federally Qualified Health Centers (FQHCs or FQHC look-alikes) that includes 15 participating clinics in phase one and 10 in phase two and a total participation of 75 clinic staff members for both phases. This project will also provide stipends to the participating clinics totaling $45,000 for a project total of $270,250.
Each training phase will offer a workshop component and customized coaching. Some of the outcomes of this project include guidance on using financial information to make informed and data- driven decisions, trends identification and analysis in revenue and expenses, profitability, balance sheet composition, and liquidity; and education on core financial concepts including thoroughly analyzing financial statements and identifying business model drivers in addition to designing financial dashboards. More details on the content and outcomes of this project are provided in the enclosed memo.
Alignment with L.A. Care Organizational Goals: By helping the safety net to be more fiscally sound in a fast-changing healthcare environment that leads to long-term financial and program sustainability, this technical assistance project aligns with L.A. Care’s mission of improving access and providing high quality care to vulnerable and low income populations in underserved areas. The project also aligns with L.A. Care’s organizational Goal 6.3 of strengthening the safety net.
L.A. Care will be acknowledged as a funder in joint press releases, L.A. Care’s logo on program literature and website acknowledgment. All contract and grant agreements will incorporate recognition activities.
Budget Impact: The Community Health Investment Fund (CHIF) allocation for fiscal year 2014- 2015 is $5.0 million, and the unspent balance to date is $3.2 million. If this request of $270,250 is approved, the CHIF balance for fiscal year 2014-2015 will be $2,929,750.
Motion: To approve an award of up to $225,250 to the Nonprofit Finance Fund (NFF), a non-profit organization, to provide financial technical assistance to Federally Qualified Health Centers (FQHCs) and FQHC look-alikes and $45,000 in stipends to participating clinics for a total project amount of $270,250.
151 May 27, 2015
TO: Executive Committee
FROM : Jonathan Freedman, Interim Chief Operating Officer Roland Palencia, Director, Community Benefit Programs
SUBJECT: Approval to award $270,250 to the Nonprofit Finance Fund (NFF) to provide financial technical assistance and to provide stipends to participating Federally Qualified Health Centers (FQHCs).
Introduction Community Benefits staff seeks approval to award $225,250 to the Nonprofit Finance Fund (NFF) to provide financial technical assistance to up to 25 Federally Qualified Health Centers (FQHCs or FQHC look-alikes), including 15 in phase one and 10 in phase two with up to 75 clinic staff members participating in both phases. This project will also provide stipends of up to $3,000 to the participating clinics totaling $45,000 for a project total of $270,250.
If this pilot project is deemed successful, Community Benefits staff will recommend, through a separate initiative, the expansion of this program to specifically target and engage private practitioners in L.A. Care’s provider network.
Issue Background L.A. Care’s Community Benefits staff has identified a need to strengthen the financial infrastructure and capacities of nonprofit safety net clinics with budgets under $20 million. These clinics are challenged to adapt to the rapidly changing healthcare environment under the Affordable Care Act. Organizations that make sound, data-driven decisions have the opportunity to financially thrive and provide care to their patients that result in better health outcomes.
In addition to making financial investments through its Community Health Investment Fund (CHIF), the Community Benefits staff also provides direct or third party technical assistance to its grantees. At a staff-sponsored meeting in July 2014—attended by 15 community-based clinic CEOs, CMOs, CFOs and CIOs— the issue of financial survival and success of the safety net in the new healthcare environment was an underlying concern. Attendees expressed that their financial challenges and limited resources impacted other organizational priorities such as patient care coordination, workforce recruitment and retention and integration and upgrade of health information technology systems among other long-term sustainability issues.
Furthermore, staff has monitored and analyzed dozens of CHIF applicants’ audited financials and other financial statements, and has been able to identify a number of fiscal challenges that have included high administrative overhead, low liquidity and cash flow difficulties (days of cash on-
152 May 27, 2015 Nonprofit Finance Fund – Financial Training and Assistance Page 2 of 4 hand), a high percentage of aged account receivables and payables, negative imbalances between assets and liabilities and untimely financial audits. Organizations that showed large deficits in a number of these areas could not submit competitive funding proposals. Staff contacted a number of funders, including the California Community Foundation, which has funded a similar program in the Los Angeles area.
In essence, the new healthcare environment provides new challenges as well as opportunities. These include the change from a fee-for-service payment structure to a capitated rate, compensation for performance and clinical outcomes rather than visits, dramatic Medicaid expansion, a new patient base with much more complex medical and social needs, diversity of payor mix, shortage of medical practitioners and the straining of internal organizational infrastructures. This training will help safety net clinics to become more financially viable, programmatically stable and become more competitive when submitting proposals to funders, including L.A. Care.
Proposed Project The financial technical assistance project, designed for clinic senior staff and FQHC Board members, will be implemented in two phases. Each training phase will have a workshop component and organizational customized coaching.
The phase one, four-hour introductory workshop will provide an in-depth look at assessing an organization’s financial operating performance and long-term financial health. This includes unpacking the information in financial statements and utilizing diagnostic tools to create a pathway to financial solvency and be able to create and analyze dashboards for effective financial decision- making and monitoring. Some of the phase one outcomes include: (1) improved skills in managing the interplay between financial risk, revenue reliability and fixed costs, (2) guidance on using financial information to make informed and data-driven decisions, (3) improved understanding of the resources and structures an organization needs to adapt to a changing environment, (4) financial tools to assist the organization to create multi-year budgets or scenario planning templates. This introductory workshop can accommodate up to 15 FQHCs and up to 45 senior clinic staff representatives (three per clinic), preferably the Executive Director, Chief Financial Officer and a board member. Each clinic will receive a stipend of $1,000 for this phase one, four-hour workshop, for a total of $15,000 for all 15 clinics.
Out of the 15 first cohort of clinics, ten will be selected to attend the phase two training, which will provide an expanded and more in-depth learning. This second workshop is also known as the Financial Leadership Clinic (FLC). The FLC will be two full-day sessions that include the following components: (1) financial diagnosis of each of the ten organizations that includes looking back three to five years of audited financial statements and one year forward-looking budget, (2) provision of trends identification and analysis in revenue, expense, profitability, balance sheet composition, and liquidity, (3) education on core financial concepts including reading financial statements and identifying business model drivers, (4) financial planning and management tools that help the leadership of the organization to make sound decisions for the overall health of the enterprise and its programs, including budgeting and cash flow management, and (5) financial presentations by each clinic to the larger cohort about their current financial condition and opportunities and risks for the coming years. Each phase two clinic will receive a $3,000 stipend for a total of $30,000 for all ten clinics.
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Prior to the FLC two-day workshop, NFF will collect three to five years of audited financial statements and the current year budget, and prepare slides that graphically depict the trends for each organization’s financial information. This pre-workshop preparation is followed by the first morning session on nonprofit finance and financial statements where each agency is provided with their financial slides and will be asked to work with NFF staff to “tell the story” of their organization’s financial situation using the provided graphs. The experience of the individual organizations will be enhanced by peer learning, conversations, and strategic sharing that occurs as part of the presentations. All of the organizations engaged in the FLC workshops can expect the following outcomes: (1) greater awareness and understanding of their organizations’ financial health and trends, (2) improved capacity to employ better planning and budgeting practices, (3) skills to use a PowerPoint presentation detailing their organization’s financials in various charts, (4) knowledge and preliminary practice in the use of nonprofit strategic financial management concepts and practices and (5) framework (that includes graphs, observations and next steps) that serves as a tool for communicating its financial condition and needs. Organizations can periodically refine and update the slides presentations that can be used during ongoing conversations with board members, staff, funders and other key constituencies.
Nonprofit Finance Fund Organizational Background NFF a 501 (c) 3 nonprofit organization was incorporated in 1984 as a Community Development Financial Institution to primarily provide access to capital, strategic financial management consulting services, and thought leadership to the nonprofit and philanthropic sectors. NFF has provided customized technical assistance to hundreds of organizations throughout the country; and in the last year alone, NFF provided individual support to over 220 organizations to build capacity and sustainability. NFF is a national organization with offices in New York, Newark, Philadelphia, Boston, Detroit, San Francisco and Los Angeles.
Locally, NFF has worked with the South Central Family Health Center, Wilmington Community Clinic and the Community Clinic Association of Los Angeles County (CCALAC).1 They provided the clinics with nonprofit business analysis (NBA), customized board training on financial management concepts by integrating NBA results and customized financial dashboards. Also, since 2012, NFF has administered the California Catalyst and Pre-Catalyst fund application process and provided technical assistance to 22 California clinics. These funds support merger and partnership opportunities for clinics in response to opportunities and challenges created under the new ACA environment.
NFF approaches its technical assistance work from an integrated perspective that includes the following key elements: Financial Capital: Does the organization have the right types and amounts of money to support ongoing operations as well as to manage risks and pursue opportunities for growth, transformation and collaboration? Intellectual Capital: Does the organization have the institutional knowledge, capabilities, technology and management tools to collect, measure, track, analyze, report on and use financial and social outcomes data to adapt/improve programs/operations and make timely and prudent strategic and tactical management decisions?
1 Staff performed due diligence with these organizations and found a high level of satisfaction with NFF’s offerings.
154 May 27, 2015 Nonprofit Finance Fund – Financial Training and Assistance Page 4 of 4
Human Capital: Does the organization have the right personnel recruitment, training, skills, experience, professional development and incentives in place to support targeted mission and program delivery outcomes and timeframes? Social Capital: Is the organization equipped to contribute to and derive value from formal and informal affiliation networks, collaborations and the interconnectedness of resources, peer learning and best practices to support the social change it seeks?
FQHC Applicant Eligibility Criteria Qualified clinics are required to be contracted with L.A. Care Health Plan and also meet the following criteria: An FQHC or FQHC look-alike that provides comprehensive primary care services. A stand-alone 501 (c) (3) non-profit agency. A clinic that serves Los Angeles County’s low-income and uninsured adults, including those without ability to pay who qualify for free or low-cost health care programs. $2 million to $20 million dollar organizational budget based on the most recent completed fiscal year.2
Application Process In partnership with NFF, L.A. Care staff will conduct a competitive request for proposal process to select participating FQHCs and FQHC look-alike clinics. Clinic applicants will be requested to submit projects that have financial strategies, specific objectives, expected outcomes and a commitment to have at least two senior management members, including the Chief Finance Officer and a Board member attend all sessions. The applications will be reviewed by staff, NFF and community experts, and recommended applicants will be brought to the Chief Executive Officer and the Chief of Strategy, Regulatory and External Affairs for final approval. As with previous initiatives, staff will provide technical assistance in submitting applications.
Evaluation The financial technical assistance initiative will be evaluated by L.A. Care staff members based on overall impact and degree to which both NFF and participating clinics accomplish their proposed goals, process and outcomes. We will receive progress reports every six months, or after completion of each series and monitor progress. The evaluation results will inform L.A. Care whether to implement a similar project with private providers in L.A. Care’s network.
Recognition Funding will be contingent upon agreement to appropriately recognize L.A. Care Health Plan. Potential recognition opportunities include individual and joint press releases, L.A. Care’s logo on program literature, website acknowledgment, annual reports and events. All contract agreements will incorporate recognition activities.
2 Depending on the number of applicants, we might consider organizations that are beyond the organizational budget range of $2 to $20 million.
155 BOARD OF GOVERNORS Executive Committee Meeting Minutes – April 30, 2015 1055 West 7th Street, Los Angeles, CA 90017 Members Management/Staff Public Thomas Horowitz, DO, Chairperson John Baackes, Chief Executive Officer Alan Bloom, Care1st Mark Gamble, Vice Chairperson Gertrude S. Carter, Chief Medical Officer Laurie Garcia, Anthem Blue Cross Michael Rembis, Treasurer Jonathan Freedman, Chief of Strategy, Regulatory and External Affairs Avanti Wadu, iHealth, Inc. Louise McCarthy, Secretary Augustavia J. Haydel, General Counsel Alexander Li, MD Tim Reilly, Chief Financial Officer G. Michael Roybal, MD, MPH Robert Turner, Chief of Human Resources
*absent ** by telephone AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN
CALL TO ORDER Thomas Horowitz, DO, Chairperson, called the meeting to order at 2:40 p.m. Thomas Horowitz, DO Chairperson Horowitz announced that members of the public may address the Committee on each matter listed on the agenda before or during the Committee’s consideration of the item, or on any other topic at the Public Comment section.
APPROVE MEETING Chairperson Horowitz announced additional motions to be placed on the list of consent Unanimously approved as AGENDA Agenda items as recommended earlier by the Finance & Budget Committee. The Agenda amended. 5 AYES for today’s meeting was approved as amended. (Gamble, Li, McCarthy, Thomas Horowitz, DO Roybal, and Horowitz).
PUBLIC COMMENTS There were no public comments. Member Rembis joined the meeting. APPROVE MEETING The minutes for the March 24, 2014 meeting were approved as presented. Unanimously approved MINUTES 6 AYES (Gamble, Li, McCarthy, Rembis, Roybal, Thomas Horowitz, DO and Horowitz).
APPROVED 156 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN
ADJOURN TO CLOSED Augustavia J. Haydel, Esq., General Counsel, announced that the following items will be discussed in closed session and the SESSION meeting adjourned to closed session at 2:40 p.m. A. CONTRACT RATES Pursuant to Welfare and Institutions Code Section 14087.38(m) Plan Partner Medical Rates Provider Rates DHCS Medi-Cal Rates B. REPORT INVOLVING TRADE SECRET Pursuant to Welfare and Institutions Code Section 14087.38(n) Including Discussion Concerning New Product Lines Estimated date of public disclosure: April 2017 C. CONFERENCE WITH LABOR NEGOTIATOR Pursuant to Section 54957 of the Ralph M. Brown Act Agency Negotiator: John Baackes Unrepresented Employee: All L.A. Care Employees
RECONVENE IN The meeting reconvened in open session at 3:15 p.m. No reportable actions were taken OPEN SESSION during the closed session.
CHAIRPERSON’s Chairperson Horowitz informed the Committee that he attended the Regional REPORT Community Advisory Committee (RCAC) Conference this morning. The conference was well attended and offered an opportunity to address stakeholders. Thomas Horowitz, DO
CHIEF EXECUTIVE John Baackes, Chief Executive Officer, reported: OFFICER’s REPORT John Wallace resigned earlier this month from his role as L.A. Care’s Chief Operating Officer (COO). His last day was today. For the past nine years Mr. Wallace provided operational leadership during a time of growth for the organization. In his role as COO he oversaw the roll out of several health care reform programs including the launch of L.A. Care Covered, transition of seniors and people with disabilities (SPDs), and dual eligible into Managed Care, as well as the expansion of Medi-Cal. Mr. Baackes noted that Mr. Wallace provided excellent leadership in his role as Interim CEO, and was very gracious with his time in helping orient Mr. Baackes to L.A. Care operations and culture.
Executive Committee April 30, 2015 Meeting Minutes APPROVED 157 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN
Jonathan Freedman, Chief of Strategy, Regulatory and External Affairs, has been appointed as interim COO, and Bruce Pollack, Sr. Director of Project Management Office, has been appointed as Core System Conversion “Czar”. UPDATE ON REVISED As discussed at prior meetings, L.A. Care was audited by the L.A. County Auditor- EXPENSE POLICIES Controller in January 2015. L.A. Care agreed with the recommendations made by the FOLLOWING L.A. Auditor-Controller, and the Finance & Budget Committee reviewed and approved the COUNTY AUDIT revised expense policies earlier today. The Auditor’s final report will be presented to the L.A. County Board of Supervisors on May 29, 2015. On May 13, 2015, I have a meeting with the Auditor Controller to better understand the scope of future audits. INCREASE IN L.A. L.A. Care will change the organization’s base wage from $13.50 to $15.00 an CARE’S MINIMUM hour. Employees making between $15.00 and $16.00 an hour will get a $.50 WAGE increase. New hires will now be eligible for health insurance and benefits sooner - 30 days after the first day of employment. These adjustments are budgeted at a cost of under $600,000 for fiscal year 2014-15. TIMING OF JUNE AND The Committee unanimously agreed to take time out of the June and July Board meetings JULY BOARD to hold strategic discussions in preparation for the upcoming Board retreat. The MEETINGS discussions will provide an opportunity to pose questions and gather feedback related to attributes for the organization to meet within the next four to five years in order to support its mission, vision and values.
COMMITTEE ISSUES
GOVERNMENT Cherie Fields, Director, Government Affairs, reported: AFFAIRS UPDATE State Budget It is anticipated that the Governor’s May State Budget Revise will be released during the week of May 11. Government Affairs will provide an analysis of the budget following the May Revise. Recent reports indicate that state is projecting revenues to exceed $4 billion. Due to the provisions of Proposition 98, most of the additional revenue will go to schools and community colleges. Debt repayment and the rainy day fund contributions are also priorities. It is unlikely that the Governor will propose any major funding restorations or new spending other than what was previously proposed in his January State Budget Proposal. (Member Rembis left the meeting.)
Executive Committee April 30, 2015 Meeting Minutes APPROVED 158 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN
Legislative Update A legislative matrix was provided with today’s meeting materials. SB 147(Federally Qualified Health Centers (FQHC) Alternative Payment Methodology) is in Senate Appropriations Committee. At this time there is no stated opposition to the bill, which it is anticipated to move to the Suspense File. The Department of Health Care Services agreed to provide comments that should allow the bill to move off the Suspense File. Bill sponsors continue working with health plans and clinics on language and expectations of the pilot program. AB 858 allows FQHC’s to receive reimbursement for mental health and primary care services rendered on the same day. This bill has a fiscal cost and it is unknown if it will move out of Appropriations and be passed by the Legislature. The Governor’s view of the bill is not known. SB 33-Medi-Cal Estate Recovery Bill would conform the state law to the more lenient federal law requirements of estate recovery requirements. This bill is scheduled to be heard in Senate Appropriations Committee. L.A. Care anticipates that this bill will be moved to the Suspense File due to the costs associated with it. OFFICER ELECTION Chairperson Horowitz informed the Committee that a Governance Committee meeting is DISCUSSION tentatively scheduled on June 9 to discuss Officer elections. Member McCarthy suggested that Board members be advised that Committee assignments may change depending on the results of Officer elections. Ms. Haydel informed the Committee that the Governance Committee has delegated authority from the Board to develop a proposed slate of officers to be forwarded to the Board. REVISED 2015 BOARD Ms. Haydel presented a motion to approve the revised Board of Governors meeting Motion EXE 100 was MEETING schedule resetting the date for the Board of Governor’s all day retreat from May 7, 2015 unanimously approved. SCHEDULE-CHANGE to September 3, 2015, and the Compliance and Quality meeting from May 21, 2015 to 5 AYES (Gamble, Li, BOARD RETREAT May 26, 2015. McCarthy, Roybal, and DATE AND Horowitz). Motion EXE 100 RESCHEDULE THE To approve the revised Board of Governors meeting schedule resetting the date for By consensus, the MAY COMPLIANCE & the Board of Governors’ Retreat from May 7, 2015 to September 3, 2015, and the Committee recommended QUALITY MEETING Compliance & Quality meeting from May 21, 2015 to May 26, 2015 as attached. this motion be included in the Consent Agenda for the May 7, 2015 Board meeting.
Executive Committee April 30, 2015 Meeting Minutes APPROVED 159 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN
SECOND QUARTER Mr. Freedman reported: ORGANIZATIONAL The second quarter organizational performance report is included in today’s meeting PERFORMANCE materials. REPORT The organizational performance report summarizes the status of organizational goals and objectives outlined in the Board approved budget for fiscal year 2014-15. Most goals are on target and some goals are partially met. These goals will be met later in the year based on strategic planning that the Board will undergo in future months.
APPROVE CONSENT The Committee approved motions to be placed on the Consent Agenda for the May 7, Unanimously approved. AGENDA ITEMS FOR 2015 Board meeting: 5 AYES THE MAY 7, 2015 1. Revised 2015 Board Meeting Schedule-Change Board Retreat Date and BOARD MEETING Reschedule the May Compliance & Quality Meeting (EXE 100) 2. Quarterly Investment Report (FIN 100) 3. Maricich Healthcare Communications Contract Amendment (FIN 103) 4. Procurement of Additional Managed Service Hours from Black Box Network Services (FIN 104) 5. Key Vendor Contract to Enhance Disk Storage Space (FIN 105) 6. Healthx Contract (FIN 106) 7. Joseph Wanski, MD Contract Renewal (FIN 107) 8. Inovalon Contract Amendment (FIN 108) 9. Gomez Research Contract (FIN 109) 10. RCAC Membership (ECA 100) 11. RCAC 4 Vice Chair Election (ECA 101)
ADJOURN The meeting adjourned at 3:36 p.m.
Respectfully submitted by: APPROVED BY: Hilda Stuart, Committee Liaison ______Linda Merkens, Manager, Board Services Thomas Horowitz, DO, Chair Date: ______
Executive Committee April 30, 2015 Meeting Minutes APPROVED 160
Board of Governors MOTION SUMMARY
Date: June 4, 2015 Motion No. FIN 109.0615
Committee: Finance & Budget Chairperson: Michael Rembis
Issue: Acceptance of the Financial Report for the seven months ended April 30, 2015.
Background:
Budget Impact:
Motion: To accept the Financial Report for the seven months ended April 30, 2015, as submitted.
161
Financial Performance April 2015
5/20/2015
162 Financial Performance Results Highlights April 2015
Overall
Total enrollment for April is 1,721,923 members which is 21,483 members unfavorable to the budget primarily due to lower than expected starting points for Plan Partners and L.A. Care Covered and higher than expected member opt-out rate for Cal MediConnect. Fiscal year-to-date (seven months) performance is a surplus of $62.4 million or 1.7% on revenue of $3.7 billion, and is $1.2 million favorable to plan. The favorable budget variance is driven by lower than expected operating and non-operating expenses.
Plan Partners
Total enrollment for April is 845,514 members which is 43,391 members unfavorable to the budget. Fiscal year-to-date performance is a surplus of $36.8 million, and is $13.0 million favorable to plan. The favorable budget variance is driven by higher than budgeted revenue rates and lower than budgeted operating expenses.
Medi-Cal Direct (MCLA) Total enrollment for April is 797,178 members. Fiscal year-to-date performance is a surplus of $64.8 million, and is $3.5 million favorable to plan driven by administrative savings.
Within MCLA, Seniors and Persons with Disabilities (SPD) enrollment is 72,884. Fiscal year-to-date performance is a deficit of $27.9 million, and is $3.6 million unfavorable to plan driven by higher than expected healthcare expenses.
Cal MediConnect (CMC)
Cal MediConnect is operated as a separate line of business that launched in April 2014 with initial membership starting in May. Membership grew by 11,265 members in 2015, primarily due to the transition of Medicare D-SNP members selecting CMC (with the closure of L.A. Care's D-SNP product) and passive enrollment. Total enrollment for April is 15,769. Fiscal year-to-date performance is a deficit of $18.7 million and is $11.0 million unfavorable to budget driven by lower than expected revenue rates.
i 163 Financial Performance Results Highlights April 2015
L.A. Care Covered (LACC)
L.A. Care Covered enrollment for April is 17,124 members. Fiscal year-to-date performance is a deficit of $23.4 million, and is $18.7 million unfavorable to plan driven by revenue revision resulting from expected Risk Adjustments from Covered California. The adjustments were retroactive to the January 2014 product launch.
Medicare
L.A. Care closed its Medicare D-SNP product line as of December 31, 2014. Fiscal year-to-date performance is a surplus of $6.8 million, and is $8.3 million favorable to plan driven by lower than budgeted healthcare expenses.
PASC-SEIU
Total enrollment for April is 45,972 members. Fiscal year-to-date performance is a deficit of $266,000, and is $445,000 unfavorable to plan driven by higher than budgeted operating expenses. Effective December 2013, L.A. Care Health Plan Joint Powers Authority (JPA) received its Knox-Keene license and PASC-SEIU became exempt from Managed Care Organization (MCO) taxes.
Healthy Kids
Total enrollment for April is 347 members. Fiscal year-to-date performance is a surplus of $91,000, and is $68,000 favorable to plan.
Community Programs
Fiscal year-to-date performance was a deficit of $5.0 million, and is $917,000 favorable to plan driven by higher than budgeted grant revenue.
HITEC-LA
The federal grant is drawn-down based upon expenses incurred. Fiscal year-to-date performance is a deficit of $114,000, and is $34,000 favorable to plan.
i 164 Combined Operations Financial Statement ($ in thousands) April 2015 Current Prior Increase YTD YTD Fav
Membership 1,721,923 1,689,099 32,824 Current Membership 1,721,923 1,743,406 (21,483) 1,744,501 1,709,847 34,654 Member Months 11,886,555 11,631,143 255,412
Revenue $583,670 334.58 $530,028 309.99 $53,642 24.59 Capitation $3,620,248 304.57 $3,559,298 306.01 $60,950 (1.45) 10,685 6.13 9,885 5.78 800 0.34 Maternity Kick 74,510 6.27 76,872 6.61 (2,362) (0.34) (9) (0.01) 36 0.02 (45) (0.03) Premiums 148 0.01 299 0.03 (150) (0.01) 90 0.05 214 0.13 (124) (0.07) Grants/Others 1,249 0.11 1,336 0.11 (87) (0.01) 594,436 340.75 540,163 315.91 54,273 24.84 Total Revenues 3,696,155 310.95 3,637,804 312.76 58,351 (1.81)
Healthcare Expenses 303,472 173.96 289,116 169.09 14,356 4.87 Capitation 2,056,829 173.04 1,960,142 168.53 (96,688) (4.51) 6,402 3.67 6,504 3.80 (102) (0.13) Maternity Kick 47,671 4.01 50,818 4.37 3,147 0.36 27,408 15.71 43,275 25.31 (15,867) (9.60) Provider Incentives and Shared Risk 159,725 13.44 76,468 6.57 (83,256) (6.86) 98,871 56.68 74,732 43.71 24,139 12.97 Inpatient Claims 485,572 40.85 531,279 45.68 45,707 4.83 93,131 53.39 83,234 48.68 9,898 4.71 Outpatient Claims 503,268 42.34 543,422 46.72 40,155 4.38 39,918 22.88 30,429 17.80 9,489 5.09 Pharmacy 201,966 16.99 211,615 18.19 9,649 1.20 6,850 3.93 6,847 4.00 4 (0.08) Medical Administrative Expenses 48,729 4.10 54,872 4.72 6,142 0.62 576,053 330.21 534,136 312.39 41,917 17.82 Total Healthcare Expenses 3,503,760 294.77 3,428,616 294.78 (75,144) 0.01 96.9% 98.9% -2.0% MCR(%) 94.8% 94.2% -0.5%
18,383 10.54 6,027 3.52 12,356 7.01 Operating Margin 192,395 16.19 209,188 17.99 (16,793) (1.80)
19,897 11.41 19,921 11.65 (24) (0.25) Total Operating Expenses 131,786 11.09 142,536 12.25 10,749 1.17 3.3% 3.7% -0.3% Admin Ratio(%) 3.6% 3.9% 0.4%
(1,514) (0.87) (13,895) (8.13) 12,380 7.26 Income from Operations 60,609 5.10 66,652 5.73 (6,043) (0.63)
(436) (0.25) 2,298 1.34 (2,734) (1.59) Total Non-Operating Income (Expense) 1,781 0.15 (5,433) (0.47) 7,214 0.62
($1,950) (1.12) ($11,596) (6.78) $9,646 5.66 Net Surplus(Deficit) $62,390 5.25 $61,219 5.26 $1,171 (0.01) -0.3% -2.1% 1.8% Margin(%) 1.7% 1.7% 0.0%
165 MediCal Plan Partner Financial Statement ($ in thousands) April 2015 Current Prior Increase YTD YTD Fav
Membership 845,514 837,244 8,270 Current Membership 845,514 888,905 (43,391) 860,203 848,527 11,676 Member Months 5,924,470 6,019,070 (94,600)
Revenue $205,280 238.64 $199,932 235.62 $5,348 3.02 Capitation $1,363,538 230.15 $1,318,502 219.05 $45,037 11.10 6,062 7.05 6,168 7.27 (106) (0.22) Maternity Kick 45,297 7.65 48,346 8.03 (3,050) (0.39) 211,342 245.69 206,101 242.89 5,241 2.80 Total Revenues 1,408,835 237.80 1,366,848 227.09 41,987 10.71
Healthcare Expenses 190,405 221.35 187,810 221.34 2,595 0.01 Capitation 1,282,160 216.42 1,238,081 205.69 (44,079) (10.72) 5,627 6.54 5,600 6.60 27 (0.06) Maternity Kick 41,660 7.03 44,354 7.37 2,694 0.34 742 0.86 2,514 2.96 (1,772) (2.10) Provider Incentives and Shared Risk 11,459 1.93 19,561 3.25 8,101 1.32 168 0.20 180 0.21 (12) (0.02) Outpatient Claims 821 0.14 0 - (821) (0.14) 786 0.91 1,003 1.18 (217) (0.27) Medical Administrative Expenses 6,662 1.12 8,968 1.49 2,307 0.37 197,728 229.86 197,108 232.29 620 (2.43) Total Healthcare Expenses 1,342,763 226.65 1,310,964 217.80 (31,799) (8.85) 93.6% 95.6% -2.1% MCR(%) 95.3% 95.9% 0.6%
13,614 15.83 8,993 10.60 4,621 5.23 Operating Margin 66,072 11.15 55,884 9.28 10,188 1.87
4,345 5.05 4,271 5.03 74 0.02 Total Operating Expenses 29,281 4.94 32,108 5.33 2,828 0.39 2.1% 2.1% 0.0% Admin Ratio(%) 2.1% 2.3% 0.3%
9,269 10.78 4,722 5.57 4,547 5.21 Income from Operations 36,791 6.21 23,776 3.95 13,016 2.26
$9,269 10.78 $4,722 5.57 $4,547 5.21 Net Surplus(Deficit) $36,791 6.21 $23,776 3.95 $13,016 2.26 4.4% 2.3% 2.1% Margin(%) 2.6% 1.7% 0.9%
166 MCLA Financial Statement ($ in thousands) April 2015 Current Prior Increase YTD YTD Fav
Membership 797,178 775,279 21,899 Current Membership 797,178 731,424 65,754 802,985 782,301 20,684 Member Months 5,374,175 4,836,542 537,633
Revenue $338,282 421.28 $286,168 365.80 $52,114 55.48 Capitation $2,025,425 376.88 $1,756,662 363.21 $268,764 13.68 4,623 5.76 3,717 4.75 906 1.01 Maternity Kick 29,214 5.44 28,525 5.90 688 (0.46) 342,905 427.04 289,885 370.55 53,020 56.48 Total Revenues 2,054,639 382.32 1,785,187 369.10 269,452 13.21
Healthcare Expenses 83,995 104.60 77,083 98.53 6,912 6.07 Capitation 616,699 114.75 500,813 103.55 (115,886) (11.20) 775 0.97 904 1.16 (129) (0.19) Maternity Kick 6,010 1.12 6,464 1.34 454 0.22 23,104 28.77 34,698 44.35 (11,594) (15.58) Provider Incentives and Shared Risk 149,873 27.89 48,459 10.02 (101,414) (17.87) 94,127 117.22 70,963 90.71 23,164 26.51 Inpatient Claims 452,582 84.21 433,991 89.73 (18,591) 5.52 91,783 114.30 77,851 99.52 13,932 14.79 Outpatient Claims 481,813 89.65 460,409 95.19 (21,404) 5.54 34,009 42.35 26,711 34.14 7,298 8.21 Pharmacy 184,158 34.27 167,353 34.60 (16,805) 0.33 3,970 4.94 4,575 5.85 (605) (0.90) Medical Administrative Expenses 27,711 5.16 29,396 6.08 1,685 0.92 331,762 413.16 292,784 374.26 38,979 38.90 Total Healthcare Expenses 1,918,847 357.05 1,646,884 340.51 (271,963) (16.54) 96.8% 101.0% -4.2% MCR(%) 93.4% 92.3% -1.1%
11,143 13.88 (2,898) (3.70) 14,041 17.58 Operating Margin 135,792 25.27 138,303 28.60 (2,511) (3.33)
11,002 13.70 11,125 14.22 (123) (0.52) Total Operating Expenses 70,983 13.21 76,997 15.92 6,014 2.71 3.2% 3.8% -0.6% Admin Ratio(%) 3.5% 4.3% 0.9%
141 0.18 (14,023) (17.93) 14,164 18.10 Income from Operations 64,809 12.06 61,306 12.68 3,503 (0.62)
$141 0.18 ($14,023) (17.93) $14,164 18.10 Net Surplus(Deficit) $64,809 12.06 $61,306 12.68 $3,503 (0.62) 0.0% -4.8% 4.9% Margin(%) 3.2% 3.4% -0.3%
167 Exhibit for information purposes only. Not a financial Statement MCLA SPD Exhibit ($ in thousands) April 2015 Current Prior Increase YTD YTD Fav
Membership 72,884 73,333 (449) Current Membership 72,884 93,627 (20,743) 71,519 73,512 (1,993) Member Months 518,132 624,785 (106,653)
Revenue 77,020 1,076.92 $71,056 966.60 $5,964 110.33 Capitation $512,817 989.74 $500,332 800.81 $12,485 188.94 77,020 1,076.92 71,056 966.60 5,964 110.33 Total Revenues 512,817 989.74 500,332 800.81 12,485 188.94
Healthcare Expenses 12,545 175.41 11,899 161.86 647 13.55 Capitation 88,633 171.06 95,122 152.25 6,490 (18.81) 130 1.81 469 6.38 (339) (4.57) Provider Incentives 980 1.89 1,445 2.31 465 0.42 2,493 34.86 0 - 2,493 34.86 DHS/DHCS Risk Sharing (3,232) (6.24) 0 - 3,232 6.24 22,714 317.59 21,148 287.68 1,566 29.91 Inpatient Claims 150,141 289.77 164,212 262.83 14,071 (26.94) 38,871 543.50 30,612 416.42 8,259 127.08 Outpatient Claims 199,377 384.80 154,739 247.67 (44,638) (137.13) 14,367 200.88 11,269 153.29 3,098 47.59 Pharmacy 80,123 154.64 79,228 126.81 (895) (27.83) 1,009 14.11 1,075 14.63 (66) (0.52) Medical Administrative Expenses 6,931 13.38 8,284 13.26 1,352 (0.12) 92,129 1,288.18 76,472 1,040.26 15,657 247.92 Total Healthcare Expenses 522,953 1,009.30 503,030 805.12 (19,923) (204.18) 119.6% 107.6% 12.0% MCR(%) 102.0% 100.5% -1.4%
(15,109) (211.25) (5,415) (73.67) (9,693) (137.59) Operating Margin (10,136) (19.56) (2,698) (4.32) (7,438) (15.25)
2,471 34.55 2,727 37.09 (256) (2.54) Total Operating Expenses 17,717 34.19 21,580 34.54 3,863 0.35 3.2% 3.8% -0.6% Admin Ratio(%) 3.5% 4.3% 0.9%
(17,580) (245.81) (8,142) (110.76) (9,438) (135.05) Income from Operations (27,853) (53.76) (24,278) (38.86) (3,575) (14.90)
($17,580) (245.81) ($8,142) (110.76) ($9,438) (135.05) Net Surplus(Deficit) ($27,853) (53.76) ($24,278) (38.86) ($3,575) (14.90) -22.8% -11.5% -11.4% Margin(%) -5.4% -4.9% -0.6%
Note: MCLA SPD Financial Statements exclude members that have Medicare as their primary coverage.
168 CMC Financial Statement ($ in thousands) April 2015 Current Prior Increase YTD YTD Fav
Membership 15,769 15,493 276 Current Membership 15,769 29,222 (13,453) 15,779 15,481 298 Member Months 73,555 121,082 (47,527)
Revenue $23,594 1,495.28 $22,841 1,475.44 $753 19.84 Capitation $108,550 1,475.77 $285,871 2,360.97 ($177,321) (885.20) 23,594 1,495.28 22,841 1,475.44 753 19.84 Total Revenues 108,550 1,475.77 285,871 2,360.97 (177,321) (885.20)
Healthcare Expenses 10,397 658.89 10,104 652.65 293 6.24 Capitation 48,551 660.07 86,198 711.90 37,647 51.83 3,089 195.79 2,877 185.82 213 9.97 Provider Incentives and Shared Risk 7,731 105.10 1,745 14.41 (5,986) (90.69) 3,227 204.49 3,876 250.37 (649) (45.88) Inpatient Claims 18,911 257.09 83,157 686.78 64,246 429.69 1,472 93.28 5,085 328.45 (3,613) (235.16) Outpatient Claims 19,229 261.42 66,885 552.39 47,656 290.98 3,836 243.12 2,306 148.98 1,530 94.14 Pharmacy 10,624 144.44 33,950 280.39 23,326 135.95 1,769 112.11 869 56.13 900 55.98 Medical Administrative Expenses 10,996 149.49 10,874 89.81 (122) (59.68) 23,790 1,507.68 25,116 1,622.40 (1,327) (114.72) Total Healthcare Expenses 116,041 1,577.61 282,809 2,335.68 166,768 758.07 100.8% 110.0% -9.1% MCR(%) 106.9% 98.9% -8.0%
(196) (12.40) (2,275) (146.96) 2,079 134.56 Operating Margin (7,491) (101.84) 3,062 25.29 (10,553) (127.13)
1,899 120.35 2,043 131.98 (144) (11.63) Total Operating Expenses 11,253 152.99 10,822 89.38 (431) (63.61) 8.0% 8.9% -0.9% Admin Ratio(%) 10.4% 3.8% -6.6%
(2,095) (132.75) (4,318) (278.94) 2,224 146.19 Income from Operations (18,744) (254.83) (7,760) (64.09) (10,984) (190.74)
($2,095) (132.75) ($4,318) (278.94) $2,224 146.19 Net Surplus(Deficit) ($18,744) (254.83) ($7,760) (64.09) ($10,984) (190.74) -8.9% -18.9% 10.0% Margin(%) -17.3% -2.7% -14.6%
169 L.A. Care Covered Financial Statement ($ in thousands) April 2015 Current Prior Increase YTD YTD Fav
Membership 17,124 14,723 2,401 Current Membership 17,124 43,779 (26,655) 19,177 17,248 1,929 Member Months 156,728 279,440 (122,712)
Revenue $2,284 119.09 $7,170 415.69 ($4,886) (296.60) Capitation ($5,604) (35.76) $66,220 236.98 ($71,825) (272.73) (9) (0.48) 36 2.09 (45) (2.57) Premiums 147 0.94 279 1.00 (132) (0.06) 2,275 118.61 7,206 417.78 (4,931) (299.17) Total Revenues * (5,457) (34.82) 66,500 237.98 (71,957) (272.79)
Healthcare Expenses 6,360 331.62 1,791 103.82 4,569 227.80 Capitation 13,136 83.81 34,300 122.75 21,165 38.93 2,387 124.49 1,186 68.78 1,201 55.72 Provider Incentives and Shared Risk (8,030) (51.24) 5,534 19.80 13,565 71.04 345 17.98 332 19.22 13 (1.24) Inpatient Claims 3,259 20.79 3,768 13.48 509 (7.31) 270 14.09 268 15.52 3 (1.42) Outpatient Claims (1,302) (8.31) 10,751 38.47 12,053 46.78 487 25.41 328 18.99 160 6.42 Pharmacy 2,441 15.57 2,643 9.46 203 (6.11) 133 6.93 153 8.89 (20) (1.96) Medical Administrative Expenses 971 6.19 3,040 10.88 2,069 4.69 9,982 520.53 4,057 235.23 5,925 285.31 Total Healthcare Expenses 10,474 66.83 60,037 214.85 49,563 148.02 438.9% 56.3% 382.6% MCR(%) -191.9% 90.3% 282.2%
(7,708) (401.92) 3,149 182.56 (10,856) (584.48) Operating Margin (15,931) (101.65) 6,463 23.13 (22,394) (124.78)
1,031 53.78 705 40.88 326 12.91 Total Operating Expenses 6,275 40.04 8,626 30.87 2,352 (9.17) 45.3% 9.8% 35.6% Admin Ratio(%) -115.0% 13.0% 128.0%
(8,739) (455.70) 2,444 141.68 (11,183) (597.38) Income from Operations (22,206) (141.68) (2,164) (7.74) (20,042) (133.94)
154 8.02 (496) (28.75) 650 36.77 Total Non-Operating Income (Expense) (1,230) (7.85) (2,618) (9.37) 1,389 1.53
($8,585) (447.68) $1,948 112.93 ($10,533) (560.61) Net Surplus(Deficit) ($23,436) (149.53) ($4,782) (17.11) ($18,653) (132.42) -377.4% 27.0% -404.5% Margin(%) 429.4% -7.2% 436.6%
* Revenue reflects retroactive adjustments to January 2014.
170 Medicare Financial Statement ($ in thousands) April 2015 Current Prior Increase YTD YTD Fav
Membership 000 Current Membership 000 2 (12) 14 Member Months 26,720 26,052 668
Revenue $0 $0 $0 Medicare Part C $24,424 914.07 $25,270 970.00 ($847) (55.93) 1 (321) 322 Medicare Part D 2,386 89.30 0 - 2,386 89.30 1 (321) 322 Total Revenues 26,810 1,003.36 25,270 970.00 1,539 33.36
Healthcare Expenses (0) (0) 0 Capitation 9,867 369.26 9,898 379.95 32 10.68 (1,916) 1,969 (3,885) Provider Incentives and Shared Risk (1,351) (50.55) 592 22.73 1,943 73.28 213 (746) 959 Inpatient Claims 8,311 311.05 7,748 297.42 (563) (13.63) (795) (289) (506) Outpatient Claims 1,563 58.50 2,364 90.74 801 32.24 0 166 (166) Pharmacy (1,518) (56.83) 2,214 85.00 3,733 141.83 (3) 22 (25) Medical Administrative Expenses 1,072 40.12 1,350 51.81 278 11.68 (2,502) 1,121 (3,623) Total Healthcare Expenses 17,944 671.56 24,167 927.64 6,223 256.08 MCR(%) 66.9% 95.6% 28.7%
2,503 (1,442) 3,945 Operating Margin 8,866 331.80 1,104 42.36 7,762 289.45
0 65 (65) Total Operating Expenses 2,069 77.42 2,570 98.65 501 21.22 Admin Ratio(%) 7.7% 10.2% 2.5%
2,503 (1,507) 4,009 Income from Operations 6,797 254.38 (1,466) (56.29) 8,263 310.67
$2,503 ($1,507) $4,009 Net Surplus(Deficit) $6,797 254.38 ($1,466) (56.29) $8,263 310.67 Margin(%) 25.4% -5.8% 31.2%
171 PASC-SEIU Financial Statement ($ in thousands) April 2015 Current Prior Increase YTD YTD Fav
Membership 45,972 45,992 (20) Current Membership 45,972 49,278 (3,306) 45,984 45,932 52 Member Months 328,445 343,371 (14,926)
Revenue $14,183 308.43 $14,187 308.88 ($4) (0.44) Capitation $101,232 308.21 $105,796 308.11 ($4,564) 0.10 14,183 308.43 14,187 308.88 (4) (0.44) Total Revenues 101,232 308.21 105,796 308.11 (4,564) 0.10
Healthcare Expenses 12,305 267.60 12,316 268.15 (11) (0.54) Capitation 86,336 262.86 90,666 264.05 4,329 1.18 0- 0 - 0 - Provider Incentives 0 - 6 0.02 6 0.02 960 20.88 319 6.95 641 13.93 Inpatient Claims 2,513 7.65 2,575 7.50 62 (0.15) 235 5.11 140 3.06 94 2.05 Outpatient Claims 1,177 3.58 2,919 8.50 1,742 4.92 1,580 34.36 915 19.92 665 14.44 Pharmacy 6,243 19.01 5,418 15.78 (825) (3.23) 194 4.23 223 4.86 (29) (0.64) Medical Administrative Expenses 1,310 3.99 1,230 3.58 (80) (0.41) 15,275 332.18 13,914 302.93 1,361 29.24 Total Healthcare Expenses 97,579 297.09 102,813 299.42 5,233 2.33 107.7% 98.1% 9.6% MCR(%) 96.4% 97.2% 0.8%
(1,092) (23.74) 273 5.94 (1,365) (29.69) Operating Margin 3,652 11.12 2,983 8.69 669 2.43
545 11.86 553 12.04 (8) (0.18) Total Operating Expenses 3,918 11.93 2,804 8.17 (1,114) (3.76) 3.8% 3.9% -0.1% Admin Ratio(%) 3.9% 2.7% -1.2%
(1,637) (35.60) (280) (6.09) (1,357) (29.51) Income from Operations (266) (0.81) 180 0.52 (445) (1.33)
($1,637) (35.60) ($280) (6.09) ($1,357) (29.51) Net Surplus(Deficit) ($266) (0.81) $180 0.52 ($445) (1.33) -11.5% -2.0% -9.6% Margin(%) -0.3% 0.2% -0.4%
172 Healthy Kids 0-5 Financial Statement ($ in thousands) April 2015 Current Prior Increase YTD YTD Fav
Membership 347 351 (4) Current Membership 347 798 (451) 352 353 (1) Member Months 2,426 5,586 (3,160)
Revenue $41 117.00 $42 117.70 ($0) (0.70) Capitation $284 117.13 $977 174.82 ($692) (57.69) 00.36 0 0.41 (0) (0.05) Premiums 1 0.48 19 3.42 (18) (2.94) 41 117.36 42 118.11 (0) (0.75) Total Revenues 285 117.61 996 178.24 (710) (60.63)
Healthcare Expenses 11 32.34 12 32.96 (0) (0.62) Capitation 80 32.92 186 33.35 106 0.43 13.72 31 86.55 (29) (82.84) Provider Incentives and Shared Risk 42 17.20 571 102.28 530 85.08 11.75 (10) (27.97) 10 29.71 Inpatient Claims (0) (0.03) 39 7.00 39 7.03 13.38 2 4.64 (0) (1.26) Outpatient Claims (16) (6.46) 95 17.00 111 23.46 4 12.35 3 9.73 1 2.62 Pharmacy 16 6.80 36 6.47 20 (0.33) 13.67 2 4.37 (0) (0.70) Medical Administrative Expenses 8 3.23 14 2.44 6 (0.79) 20 57.22 39 110.29 (19) (53.08) Total Healthcare Expenses 130 53.67 941 168.54 811 114.87 48.8% 93.4% -44.6% MCR(%) 45.6% 94.6% 48.9%
21 60.15 3 7.82 18 52.33 Operating Margin 155 63.94 54 9.70 101 54.25
14 38.41 4 10.05 10 28.36 Total Operating Expenses 64 26.35 31 5.51 (33) (20.85) 32.7% 8.5% 24.2% Admin Ratio(%) 22.4% 3.1% -19.3%
8 21.74 (1) (2.23) 8 23.96 Income from Operations 91 37.59 23 4.19 68 33.40
$8 21.74 ($1) (2.23) $8 23.96 Net Surplus(Deficit) $91 37.59 $23 4.19 $68 33.40 18.5% -1.9% 20.4% Margin(%) 32.0% 2.4% 29.6%
173 Community Programs Financial Statement ($ in thousands) April 2015 Current Prior Increase YTD YTD Fav
Membership 000 Current Membership 000 000 Member Months 000
Revenue $39 - $20 - $19 - Grants/Others $222 - $0 - $222 - 0- 0 - 0 - Capitation 0 - 0 - 0 - 39 - 20 - 19 - Total Revenues 222 - 0 - 222 -
Healthcare Expenses 0- 0 - 0 - Medical Administrative Expenses 0 - 0 - 0 - 0- 0 - 0 - Total Healthcare Expenses 0 - 0 - 0 - 0.0% 0.0% 0.0% MCR(%) 0.0% 0.0% 0.0%
39 - 20 - 19 - Operating Margin 222 - 0 - 222 -
492 - 417 - 74 - Total Operating Expenses 3,247 - 3,010 - (236) - 0.0% 0.0% 0.0% Admin Ratio(%) 0.0% 0.0% 0.0%
(453) - (398) - (55) - Income from Operations (3,025) - (3,010) - (15) -
0- 0 - 0 - Total Non-Operating Income (Expense) (1,985) - (2,917) - 932 -
($453) 0.00 ($398) 0.00 ($55) 0.00 Net Surplus(Deficit) ($5,010) 0.00 ($5,927) 0.00 $917 0.00 0.0% 0.0% 0.0% Margin(%) 0.0% 0.0% 0.0%
174 HITEC-LA Financial Statement ($ in thousands) April 2015 Current Prior Increase YTD YTD Fav
Membership 000 Current Membership 000 000 Member Months 000
Revenue $51 - $194 - ($143) - Grants/Others $1,027 - $1,336 - ($309) - 0- 0 - 0 - Capitation 0 - 0 - 0 - 51 - 194 - (143) - Total Revenues 1,027 - 1,336 - (309) -
Healthcare Expenses 0- 0 - 0 - Medical Administrative Expenses 0 - 0 - 0 - 0- 0 - 0 - Total Healthcare Expenses 0 - 0 - 0 - 0.0% 0.0% 0.0% MCR(%) 0.0% 0.0% 0.0%
51 - 194 - (143) - Operating Margin 1,027 - 1,336 - (309) -
57 - 216 - (159) - Total Operating Expenses 1,141 - 1,484 - 343 - 0.0% 0.0% 0.0% Admin Ratio(%) 0.0% 0.0% 0.0%
(6) - (21) - 16 - Income from Operations (114) - (148) - 34 -
($6) 0.00 ($21) 0.00 $16 0.00 Net Surplus(Deficit) ($114) 0.00 ($148) 0.00 $34 0.00 0.0% 0.0% 0.0% Margin(%) 0.0% 0.0% 0.0%
175 Comparative Balance Sheet April 2015
(Dollars in thousands) Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 ASSETS
CURRENT ASSETS Total Current Assets 1,578,110 1,948,116 2,452,736 2,292,462 2,132,513 1,955,883 Capitalized Assets - net 31,328 32,159 32,190 34,524 35,219 37,286 NON-CURRENT ASSETS 10,160 10,138 10,150 10,153 10,315 10,300 TOTAL ASSETS 1,619,598 1,990,414 2,495,077 2,337,139 2,178,047 2,003,469
LIABILITIES AND FUND EQUITY
CURRENT LIABILITIES Total Current Liability 1,353,803 1,713,835 2,203,011 2,037,462 1,889,970 1,717,348 Long Term Liability 3,497 3,582 3,646 3,665 3,661 3,657 Total Liabilities 1,357,300 1,717,417 2,206,657 2,041,127 1,893,631 1,721,004
FUND EQUITY Invested in Capital Assets, net of related debt 31,328 32,159 32,190 34,524 35,219 37,286 Restricted Equity 300 300 300 300 300 300 Minimum Tangible Net Equity 89,784 95,674 101,450 105,377 111,888 120,052 Board Designated Funds 140,886 144,864 154,479 155,810 137,008 124,826 Total Fund Equity 262,298 272,997 288,420 296,011 284,415 282,465
TOTAL LIABILITIES AND FUND EQUITY $1,619,598 $1,990,414 $2,495,077 $2,337,139 $2,178,045 $2,003,469
Solvency Ratios
Working Capital Ratio 1.17 1.14 1.11 1.13 1.13 1.14 Cash to Claims Ratio 0.60 1.36 1.33 1.34 1.19 1.25 Tangible Net Equity Ratio 2.92 2.85 2.84 2.81 2.54 2.35
176 DATE: May 27, 2015 TO: Finance & Budget Committee FROM: Timothy Reilly, Chief Financial Officer
SUBJECT: Monthly Investment Transaction Report – April 2015
In order to keep the Committee apprised of L.A. Care’s investment portfolios and to comply with California government code section #53607, presented herein are the investment transaction details from April 1, 2015, to April 30, 2015.
As of April 30, 2015, L.A. Care's total investments market value was $1,493 million. This includes $50 million invested with the Los Angeles County Pooled Investment Fund (LACPIF) and $10 million invested with the Local Agency Investment Fund (LAIF). These government pooled funds are overseen by the County Treasurer (LACPIF) and State Treasurers Office (LAIF). The remainder, $1,433 million, is managed by Payden & Rygel, an external professional asset management firm and is divided to two separate portfolios based on investment style, 1. The Short-term Portfolio and 2. The Extended Portfolio
Presented herewith the transactions related to these portfolios.
177 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN 04/01/2015 Account Number: through 04/30/2015
Trade Settlement Transaction MaturityCoupon Accrued Interest Total D a te D a te T y pe U nits De scr i p tion D a te R a te C U S IP Pr o cee ds / ( Co s t) ( P u rc h ) o r Sold Amount 03/27/15 04/01/15 Buy 4,410,000.000 STATE STREET BANK FRN 12/08/15 0.46 85744NAB7 (4,407,750.90) (1,362.98) (4,409,113.88)
03/25/15 04/02/15 Buy 10,900,000.000 FFCB 1ML FRN 01/02/18 0.22 3133EEWS (10,899,392.87) (10,899,392.87)
04/08/15 04/08/15 Buy 50,000,000.000 U.S. TREASURY BILL 04/09/15 912796FC8 (49,999,958.33) (49,999,958.33)
04/07/15 04/10/15 Buy 750,000.000 NSTAR ELECTRIC FRN 05/17/16 0.50 67021CAH0 (749,385.00) (538.53) (749,923.53)
04/08/15 04/13/15 Buy 2,000,000.000 PNC BANK 01/28/16 0.80 69349LAH1 (2,004,080.00) (3,333.33) (2,007,413.33)
04/08/15 04/13/15 Buy 4,020,000.000 TOYOTA 2014-B A3 CAR 03/15/18 0.76 89231RAC8 (4,018,429.69) (2,376.27) (4,020,805.96)
04/10/15 04/14/15 Buy 7,500,000.000 PRIVATE EXPORT FUNDING CP 01/05/16 7426M2A5 (7,480,604.17) (7,480,604.17)
04/10/15 04/15/15 Buy 1,500,000.000 ORACLE FRN 07/07/17 0.47 68389XAT2 (1,501,710.00) (156.92) (1,501,866.92)
04/10/15 04/15/15 Buy 3,820,000.000 USAA 2014-1 A3 CAR 12/15/17 0.58 90290KAC9 (3,818,657.03) (3,818,657.03)
04/10/15 04/15/15 Buy 3,250,000.000 US BANK CINCINNATI FRN 01/30/17 0.51 90331HMD (3,252,892.50) (3,281.15) (3,256,173.65)
04/09/15 04/16/15 Buy 6,925,000.000 FFCB 1ML FRN 04/16/18 0.23 3133EEZC7 (6,923,950.38) (6,923,950.38)
04/10/15 04/16/15 Buy 2,900,000.000 NEW YORK UNIVERSITY 07/01/17 0.90 650119AD2 (2,900,000.00) (2,900,000.00)
04/16/15 04/17/15 Buy 50,000,000.000 U.S. TREASURY NOTE 08/31/16 0.50 912828D64 (50,109,542.50) (32,608.70) (50,142,151.20)
04/15/15 04/20/15 Buy 2,650,000.000 AMERICAN EXPRESS FRN 06/05/17 0.54 0258M0DN (2,646,793.50) (1,812.08) (2,648,605.58)
04/15/15 04/20/15 Buy 3,500,000.000 PFIZER FRN 05/15/17 0.41 717081DP5 (3,500,560.00) (2,453.91) (3,503,013.91)
04/20/15 04/21/15 Buy 25,000,000.000 FHLB DISCOUNT NOTE 04/24/15 313384ET2 (24,999,916.67) (24,999,916.67)
04/20/15 04/21/15 Buy 13,290,000.000 FHLB DISCOUNT NOTE 04/24/15 313384ET2 (13,289,961.24) (13,289,961.24)
04/20/15 04/21/15 Buy 16,600,000.000 FHLB DISCOUNT NOTE 04/24/15 313384ET2 (16,599,944.67) (16,599,944.67)
04/20/15 04/21/15 Buy 30,000,000.000 FHLB DISCOUNT NOTE 05/06/15 313384FF1 (29,999,375.00) (29,999,375.00)
04/17/15 04/21/15 Buy 130,000.000 JOHN DEERE 2015-A A2A EQP 02/15/18 0.87 47787UAB9 (130,218.36) (18.85) (130,237.21)
Payden & Rygel 178 Page 1 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN 04/01/2015 Account Number: through 04/30/2015
Trade Settlement Transaction MaturityCoupon Accrued Interest Total D a te D a te T y pe U nits De scr i p tion D a te R a te C U S IP Pr o cee ds / ( Co s t) ( P u rc h ) o r Sold Amount 04/21/15 04/22/15 Buy 50,000,000.000 FHLB DISCOUNT NOTE 05/15/15 313384FQ7 (49,998,243.06) (49,998,243.06)
04/17/15 04/22/15 Buy 600,000.000 IBM FRN 02/06/18 0.45 459200JA0 (600,696.00) (556.38) (601,252.38)
04/17/15 04/22/15 Buy 487,000.000 COCA-COLA 09/01/16 1.80 191216AU4 (495,610.16) (1,241.85) (496,852.01)
04/15/15 04/22/15 Buy 5,600,000.000 RICE UNIVERSITY 05/15/16 0.50 96926GAB9 (5,600,000.00) (5,600,000.00)
04/22/15 04/23/15 Buy 50,000,000.000 U.S. TREASURY NOTE 03/31/16 0.38 912828C40 (50,064,620.63) (11,782.79) (50,076,403.42)
04/22/15 04/23/15 Buy 50,000,000.000 U.S. TREASURY FRN 01/31/17 0.11 912828H60 (50,014,408.09) (12,059.89) (50,026,467.98)
04/24/15 04/24/15 Buy 50,000,000.000 FHLB DISCOUNT NOTE 05/15/15 313384FQ7 (49,998,541.67) (49,998,541.67)
04/23/15 04/24/15 Buy 50,000,000.000 FHLB DISCOUNT NOTE 05/22/15 313384FX2 (49,997,861.11) (49,997,861.11)
04/24/15 04/24/15 Buy 50,000,000.000 FHLB DISCOUNT NOTE 05/22/15 313384FX2 (49,997,861.11) (49,997,861.11)
04/23/15 04/24/15 Buy 27,000,000.000 FNMA DISCOUNT NOTE 05/01/15 313588FA8 (26,999,763.75) (26,999,763.75)
04/24/15 04/24/15 Buy 25,000,000.000 FNMA DISCOUNT NOTE 06/02/15 313588GJ8 (24,998,510.42) (24,998,510.42)
04/24/15 04/24/15 Buy 50,000,000.000 FNMA DISCOUNT NOTE 07/01/15 313588HP3 (49,993,861.11) (49,993,861.11)
04/21/15 04/24/15 Buy 2,700,000.000 GEEMT 2014-1 A2 EQP 04/24/17 0.64 36163TAB9 (2,700,316.41) (96.00) (2,700,412.41)
04/21/15 04/24/15 Buy 1,500,000.000 NATL RURAL UTILITIES 11/01/15 1.90 637432ML6 (1,511,985.00) (13,695.83) (1,525,680.83)
04/22/15 04/27/15 Buy 750,000.000 MERCK & CO 05/18/16 0.70 58933YAD7 (751,882.50) (2,318.75) (754,201.25)
04/23/15 04/28/15 Buy 11,538,078.460 NGN 2011-R4 1A 1MOFRN NCUA 03/06/20 0.56 62889FAA0 (11,565,120.83) (3,931.31) (11,569,052.14)
04/22/15 04/29/15 Buy 7,200,000.000 CHASE 2015-A3 A CDT 04/15/19 0.43 161571GW (7,200,000.00) (7,200,000.00)
04/28/15 04/30/15 Buy 10,000,000.000 FFCB 1ML 01/17/18 0.21 3133EEZM5 (9,998,700.00) (759.78) (9,999,459.78)
04/28/15 04/30/15 Buy 10,000,000.000 FFCB 3ML 09/12/17 0.20 3133EETJ9 (9,998,900.00) (2,690.92) (10,001,590.92)
04/15/15 04/30/15 Buy 3,750,000.000 FNA 2015-M7 ASQ2 04/25/18 1.55 3136ANJY4 (3,787,486.50) (4,682.29) (3,792,168.79)
Payden & Rygel 179 Page 2 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN 04/01/2015 Account Number: through 04/30/2015
Trade Settlement Transaction MaturityCoupon Accrued Interest Total D a te D a te T y pe U nits De scr i p tion D a te R a te C U S IP Pr o cee ds / ( Co s t) ( P u rc h ) o r Sold Amount 04/27/15 04/30/15 Buy 2 ,500 , 000 . 000 PEPSICO 04/30/18 1.25 713448CR7 (2 ,499 , 700 . 00) (2 ,499 , 700 . 00) 697,770,078.460 (698,007,191.16) (101,758.51) (698,108,949.67)
04/01/15 04/01/15 Coupon CA GOLDEN EMPIRE SFA LEASE 05/01/15 0.31 381008AR2 204.33 204.33
04/02/15 04/02/15 Coupon GE CAPITAL CORP FRN 04/02/18 0.98 36962G6X7 8,928.10 8,928.10
04/03/15 04/03/15 Coupon FFCB 1ML FRN 10/03/16 0.20 3133ED3B6 830.97 830.97
04/06/15 04/06/15 Coupon NGN 2010-R2 1A 1MOFRN NCUA 11/06/17 0.55 62888UAA8 1,133.10 1,133.10
04/07/15 04/07/15 Coupon NATL RURAL UTILITIES FRN 05/01/15 0.32 63743HEJ7 721.05 721.05
04/07/15 04/07/15 Coupon ORACLE FRN 07/07/17 0.47 68389XAT2 907.20 907.20
04/07/15 04/07/15 Coupon ORACLE FRN 07/07/17 0.47 68389XAT2 290.30 290.30
04/07/15 04/07/15 Coupon ORACLE FRN 07/07/17 0.47 68389XAT2 1,247.40 1,247.40
04/07/15 04/07/15 Coupon ORACLE FRN 07/07/17 0.47 68389XAT2 4,359.10 4,359.10
04/08/15 04/08/15 Coupon FFCB 1ML FRN 07/08/16 0.20 3133ED4K5 503.75 503.75
04/10/15 04/10/15 Coupon METLIFE GLOBAL FRN 144A 04/10/17 0.65 59217GBE8 2,317.70 2,317.70
04/11/15 04/11/15 Coupon DUKE ENERGY INDIANA FRN 07/11/16 0.63 263901AE0 466.63 466.63
04/11/15 04/11/15 Coupon DUKE ENERGY INDIANA FRN 07/11/16 0.63 263901AE0 662.31 662.31
04/11/15 04/11/15 Coupon DUKE ENERGY INDIANA FRN 07/11/16 0.63 263901AE0 4,774.65 4,774.65
04/11/15 04/11/15 Coupon DUKE ENERGY INDIANA FRN 07/11/16 0.63 263901AE0 346.21 346.21
04/11/15 04/11/15 Coupon DUKE ENERGY INDIANA FRN 07/11/16 0.63 263901AE0 263.42 263.42
04/11/15 04/11/15 Coupon DUKE ENERGY INDIANA FRN 07/11/16 0.63 263901AE0 1,994.46 1,994.46
04/11/15 04/11/15 Coupon DUKE ENERGY INDIANA FRN 07/11/16 0.63 263901AE0 270.95 270.95
Payden & Rygel 180 Page 3 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN 04/01/2015 Account Number: through 04/30/2015
Trade Settlement Transaction MaturityCoupon Accrued Interest Total D a te D a te T y pe U nits De scr i p tion D a te R a te C U S IP Pr o cee ds / ( Co s t) ( P u rc h ) o r Sold Amount 04/11/15 04/11/15 Coupon WAL-MART STORES 04/11/16 0.60 931142DE0 1,500.00 1,500.00
04/11/15 04/11/15 Coupon WAL-MART STORES 04/11/16 0.60 931142DE0 2,520.00 2,520.00
04/11/15 04/11/15 Coupon WAL-MART STORES 04/11/16 0.60 931142DE0 3,330.00 3,330.00
04/11/15 04/11/15 Coupon WAL-MART STORES 04/11/16 0.60 931142DE0 2,520.00 2,520.00
04/11/15 04/11/15 Coupon WAL-MART STORES 04/11/16 0.60 931142DE0 6,975.00 6,975.00
04/11/15 04/11/15 Coupon WAL-MART STORES 04/11/16 0.60 931142DE0 3,900.00 3,900.00
04/13/15 04/13/15 Coupon BERKSHIRE HATHAWAY FRN 01/12/18 0.58 084664CD1 10,143.83 10,143.83
04/13/15 04/13/15 Coupon BERKSHIRE HATHAWAY FRN 01/12/18 0.58 084664CD1 777.69 777.69
04/13/15 04/13/15 Coupon JOHN DEERE CAPITAL FRN 10/11/16 0.57 24422ESE0 301.47 301.47
04/13/15 04/13/15 Coupon FFCB 1ML FRN 02/13/17 0.22 3133EDFB3 930.00 930.00
04/15/15 04/15/15 Coupon HONDA 2014-4 A2 CAR 01/17/17 0.58 43814JAB0 596.92 596.92
04/15/15 04/15/15 Coupon HONDA 2015-1 A2 CAR 06/15/17 0.70 43814KAB7 991.67 991.67
04/15/15 04/15/15 Coupon JOHN DEERE 2014-A A3 EQP 04/16/18 0.92 47787VAC5 2,319.17 2,319.17
04/15/15 04/15/15 Coupon JOHN DEERE 2015-A A2A EQP 02/15/18 0.87 47787UAB9 4,034.38 4,034.38
04/15/15 04/15/15 Coupon JPMORGAN CHASE 10/15/15 1.10 46623EJR1 2,750.00 2,750.00
04/15/15 04/15/15 Coupon ORACLE FRN 01/15/19 0.86 68389XAR6 2,447.82 2,447.82
04/15/15 04/15/15 Coupon ORACLE FRN 01/15/19 0.86 68389XAR6 1,072.87 1,072.87
04/15/15 04/15/15 Coupon ALABAMA POWER 10/15/15 0.55 010392FH6 4,125.00 4,125.00
04/15/15 04/15/15 Coupon TOYOTA 2014-B A3 CAR 03/15/18 0.76 89231RAC8 2,546.00 2,546.00
04/15/15 04/15/15 Coupon TOYOTA 2015-A A2 CAR 07/17/17 1.01 89236WAB 3,312.80 3,312.80
Payden & Rygel 181 Page 4 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN 04/01/2015 Account Number: through 04/30/2015
Trade Settlement Transaction MaturityCoupon Accrued Interest Total D a te D a te T y pe U nits De scr i p tion D a te R a te C U S IP Pr o cee ds / ( Co s t) ( P u rc h ) o r Sold Amount 04/15/15 04/15/15 Coupon U.S. TREASURY NOTE 04/15/16 0.25 912828UW 1,250.00 1,250.00
04/15/15 04/15/15 Coupon USAA 2012-1 A3 CAR 08/15/16 0.43 90327BAC6 5.97 5.97
04/15/15 04/15/15 Coupon USAA 2014-1 A2 CAR 10/17/16 0.38 90290KAB1 60.61 60.61
04/15/15 04/15/15 Coupon USAA 2014-1 A2 CAR 10/17/16 0.38 90290KAB1 41.33 41.33
04/15/15 04/15/15 Coupon USAA 2014-1 A3 CAR 12/15/17 0.58 90290KAC9 512.33 512.33
04/16/15 04/16/15 Coupon JOHN DEERE CAPITAL CORP FR 01/16/18 0.57 24422ESU4 10,192.50 10,192.50
04/17/15 04/17/15 Coupon FFCB 1ML FRN 04/17/17 0.23 3133EDJX1 585.13 585.13
04/20/15 04/20/15 Coupon GEDFT 2013-1 A 1MOFRN FLOO 04/20/18 0.58 36159LCF1 483.60 483.60
04/20/15 04/20/15 Coupon GEDFT 2013-1 A 1MOFRN FLOO 04/20/18 0.58 36159LCF1 243.04 243.04
04/20/15 04/20/15 Coupon GEDFT 2013-1 A 1MOFRN FLOO 04/20/18 0.58 36159LCF1 595.20 595.20
04/20/15 04/20/15 Coupon WELLS FARGO FRN 07/20/16 0.81 94974BFM7 589.95 589.95
04/20/15 04/20/15 Coupon WELLS FARGO FRN 07/20/16 0.81 94974BFM7 2,359.80 2,359.80
04/22/15 04/22/15 Coupon GEEMT 2014-1 A2 EQP 04/24/17 0.64 36163TAB9 480.00 480.00
04/23/15 04/23/15 Coupon BNY MELLON 10/23/15 0.70 06406HCD 1,750.00 1,750.00
04/23/15 04/23/15 Coupon BNY MELLON 10/23/15 0.70 06406HCD 7,000.00 7,000.00
04/23/15 04/23/15 Coupon BNY MELLON 10/23/15 0.70 06406HCD 4,550.00 4,550.00
04/23/15 04/23/15 Coupon BNY MELLON FRN 10/23/15 0.51 06406HCF4 1,217.75 1,217.75
04/23/15 04/23/15 Coupon GEET 2015-1 A2 EQP 11/24/17 0.89 36164EAB1 1,580.86 1,580.86
04/23/15 04/23/15 Coupon NEW YORK LIFE GLOBAL FRN 14 05/23/16 0.63 64952WBP 758.88 758.88
04/23/15 04/23/15 Coupon WELLS FARGO FRN 04/23/18 0.91 94974BFK1 2,217.75 2,217.75
Payden & Rygel 182 Page 5 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN 04/01/2015 Account Number: through 04/30/2015
Trade Settlement Transaction MaturityCoupon Accrued Interest Total D a te D a te T y pe U nits De scr i p tion D a te R a te C U S IP Pr o cee ds / ( Co s t) ( P u rc h ) o r Sold Amount 04/23/15 04/23/15 Coupon WELLS FARGO FRN 04/23/18 0.91 94974BFK1 6,653.25 6,653.25
04/24/15 04/24/15 Coupon GEET 2013-2 A2 EQP 06/24/16 0.61 36163GAB7 267.42 267.42
04/25/15 04/25/15 Coupon FHMS KF01 A 1MOFRN CMBS 04/25/19 0.52 3137AUP52 238.27 238.27
04/01/15 04/25/15 Coupon FNA 2014-M2 ASQ2 CMBS 09/25/15 0.48 3136AJDN3 181.59 181.59
04/01/15 04/25/15 Coupon FNA 2014-M2 ASQ2 CMBS 09/25/15 0.48 3136AJDN3 72.63 72.63
04/01/15 04/25/15 Coupon FNA 2014-M3 ASQ2 03/25/16 0.56 3136AJKZ8 3,309.47 3,309.47
04/01/15 04/25/15 Coupon FNA 2014-M5 FA 1MOFRN CMBS 01/25/17 0.56 3136AJ2A3 241.16 241.16
04/01/15 04/25/15 Coupon FNA 2014-M8 FA 1MOFRN CMBS 05/25/18 0.44 3136AKQJ5 555.61 555.61
04/01/15 04/25/15 Coupon FNA 2015-M3 FA 1MOFRN CMBS 06/25/18 0.42 3136AMMC 471.88 471.88
04/01/15 04/25/15 Coupon FNA 2015-M4 FA 1MOFRN CMBS 09/25/18 0.38 3136AMTM 4,485.83 4,485.83
04/27/15 04/27/15 Coupon JPMORGAN CHASE FRN 01/25/18 1.18 46625HJF8 3,886.74 3,886.74
04/27/15 04/27/15 Coupon JPMORGAN CHASE FRN 01/25/18 1.18 46625HJF8 1,957.98 1,957.98
04/27/15 04/27/15 Coupon JPMORGAN CHASE FRN 01/25/18 1.18 46625HJF8 2,922.36 2,922.36
04/28/15 04/28/15 Coupon PNC BANK FRN 01/28/16 0.59 69349LAJ7 1,415.25 1,415.25
04/28/15 04/28/15 Coupon PNC BANK FRN 01/28/16 0.59 69349LAJ7 353.81 353.81
04/29/15 04/29/15 Coupon AMERICAN EXPRESS FRN 07/29/16 0.79 0258M0DH 1,048.58 1,048.58
04/29/15 04/29/15 Coupon AMERICAN EXPRESS FRN 07/29/16 0.79 0258M0DH 3,717.68 3,717.68
04/29/15 04/29/15 Coupon AMERICAN EXPRESS FRN 07/29/16 0.79 0258M0DH 2,859.75 2,859.75
04/30/15 04/30/15 Coupon MANUFACTURERS & TRADERS T 01/30/17 0.65 55279HAC4 787.00 787.00
04/30/15 04/30/15 Coupon MANUFACTURERS & TRADERS T 01/30/17 0.65 55279HAC4 944.40 944.40
Payden & Rygel 183 Page 6 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN 04/01/2015 Account Number: through 04/30/2015
Trade Settlement Transaction MaturityCoupon Accrued Interest Total D a te D a te T y pe U nits De scr i p tion D a te R a te C U S IP Pr o cee ds / ( Co s t) ( P u rc h ) o r Sold Amount 04/30/15 04/30/15 Coupon MANUFACTURERS & TRADERS T 01/30/17 0.65 55279HAC4 708.30 708.30
04/30/15 04/30/15 Coupon MANUFACTURERS & TRADERS T 01/30/17 0.65 55279HAC4 1,023.10 1,023.10
04/30/15 04/30/15 Coupon U.S. TREASURY FRN 01/31/17 0.11 912828H60 13,119.68 13,119.68
04/30/15 04/30/15 Coupon U.S. TREASURY FRN 01/31/16 0.07 912828WK 174.11 174.11
04/30/15 04/30/15 Coupon U.S. TREASURY FRN 01/31/16 0.07 912828WK 307.22 307.22
04/30/15 04/30/15 Coupon US BANK CINCINNATI FRN 01/30/17 0.51 90331HMD 605.75 605.75
04/30/15 04/30/15 Coupon US BANK CINCINNATI FRN 01/30/17 0.51 90331HMD 2,423.00 2,423.00
04/30/15 04/30/15 Coupon US BANK CINCINNATI FRN 01/30/17 0.51 90331HMD 1,514.38 1,514.38
04/30/15 04/30/15 Coupon US BANK CINCINNATI FRN 01/30/17 0.51 90331HMD 605.75 605.75 04/30/15 04/30/15 Coupon US BANK CINCINNATI FRN 01/30/17 0.51 90331HMD 3 , 937 . 38 3 , 937 . 38 184,580.28 184,580.28
04/01/15 04/01/15 Income 717.160 STIF INT USD 717.16 717.16 04/01/15 04/01/15 Income 62 . 410 ADJ NET INT USD 62 . 41 62 . 41 779.570 779.57 779.57
04/24/15 04/24/15 Contributn 230,000,000.000 NM USD 230,000,000.00 230,000,000.00
04/07/15 04/08/15 Sell Long 25,000,000.000 FHLB DISCOUNT NOTE 04/09/15 313384EC9 24,998,638.89 1,361.11 25,000,000.00
04/07/15 04/08/15 Sell Long 25,000,000.000 FHLB DISCOUNT NOTE 04/09/15 313384EC9 24,999,104.17 895.83 25,000,000.00
04/08/15 04/09/15 Sell Long 25,000,000.000 FHLB DISCOUNT NOTE 05/08/15 313384FH7 24,997,522.92 1,369.44 24,998,892.36
04/10/15 04/13/15 Sell Long 50,000,000.000 FHLB DISCOUNT NOTE 06/05/15 313384GM 49,991,111.12 3,588.88 49,994,700.00
Payden & Rygel 184 Page 7 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN 04/01/2015 Account Number: through 04/30/2015
Trade Settlement Transaction MaturityCoupon Accrued Interest Total D a te D a te T y pe U nits De scr i p tion D a te R a te C U S IP Pr o cee ds / ( Co s t) ( P u rc h ) o r Sold Amount 04/10/15 04/13/15 Sell Long 6,250,000.000 FHLMC DISCOUNT NOTE 05/04/15 313396FD0 6,249,204.17 598.96 6,249,803.13
04/10/15 04/13/15 Sell Long 43,750,000.000 FHLMC DISCOUNT NOTE 05/04/15 313396FD0 43,744,009.90 4,611.97 43,748,621.87
04/10/15 04/13/15 Sell Long 50,000,000.000 FNMA DISCOUNT NOTE 05/21/15 313588FW 49,989,788.89 7,097.22 49,996,886.11
04/09/15 04/16/15 Sell Long 3,000,000.000 FFCB 1ML FRN 07/08/16 0.20 3133ED4K5 3,001,701.00 133.17 3,001,834.17
04/16/15 04/17/15 Sell Long 50,000,000.000 U.S. TREASURY NOTE 07/15/15 0.25 912828TD2 50,026,500.00 31,767.96 50,058,267.96
04/16/15 04/17/15 Sell Long 50,000,000.000 U.S. TREASURY NOTE 07/15/15 0.25 912828TD2 50,026,500.00 31,767.96 50,058,267.96
04/22/15 04/23/15 Sell Long 50,000,000.000 U.S. TREASURY NOTE 06/30/15 0.38 912828VH0 50,029,129.38 58,529.01 50,087,658.39
04/22/15 04/23/15 Sell Long 50,000,000.000 U.S. TREASURY NOTE 06/30/15 0.38 912828VH0 50,029,129.38 58,529.01 50,087,658.39 04/29/15 04/30/15 Sell Long 20 ,000 , 000 . 000 FNMA DISCOUNT NOTE 05/01/15 313588FA8 19 ,999 , 838 . 89 150 . 00 19 ,999 , 988 . 89 448,000,000.000 448,082,178.70 200,400.53 448,282,579.23
04/06/15 04/06/15 Pay Princpl 43,836.012 NGN 2010-R2 1A 1MOFRN NCUA 11/06/17 0.55 62888UAA8 43,836.01 43,836.01
04/15/15 04/15/15 Pay Princpl 8,756.675 USAA 2012-1 A3 CAR 08/15/16 0.43 90327BAC6 8,756.68 8,756.68
04/15/15 04/15/15 Pay Princpl 44,550.082 USAA 2014-1 A2 CAR 10/17/16 0.38 90290KAB1 44,550.08 44,550.08
04/15/15 04/15/15 Pay Princpl 30,375.056 USAA 2014-1 A2 CAR 10/17/16 0.38 90290KAB1 30,375.06 30,375.06
04/24/15 04/24/15 Pay Princpl 125,215.689 GEET 2013-2 A2 EQP 06/24/16 0.61 36163GAB7 125,215.69 125,215.69
04/25/15 04/25/15 Pay Princpl 1,408.320 FHMS KF01 A 1MOFRN CMBS 04/25/19 0.52 3137AUP52 1,408.32 1,408.32
04/01/15 04/25/15 Pay Princpl 35,346.090 FNA 2014-M2 ASQ2 CMBS 09/25/15 0.48 3136AJDN3 35,346.09 35,346.09
04/01/15 04/25/15 Pay Princpl 14,138.440 FNA 2014-M2 ASQ2 CMBS 09/25/15 0.48 3136AJDN3 14,138.44 14,138.44
04/01/15 04/25/15 Pay Princpl 637,061.850 FNA 2014-M3 ASQ2 03/25/16 0.56 3136AJKZ8 637,061.85 637,061.85
04/01/15 04/25/15 Pay Princpl 26,877.480 FNA 2014-M5 FA 1MOFRN CMBS 01/25/17 0.56 3136AJ2A3 26,877.48 26,877.48
Payden & Rygel 185 Page 8 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN 04/01/2015 Account Number: through 04/30/2015
Trade Settlement Transaction MaturityCoupon Accrued Interest Total D a te D a te T y pe U nits De scr i p tion D a te R a te C U S IP Pr o cee ds / ( Co s t) ( P u rc h ) o r Sold Amount 04/01/15 04/25/15 Pay Princpl 29,693.579 FNA 2014-M8 FA 1MOFRN CMBS 05/25/18 0.44 3136AKQJ5 29,693.58 29,693.58
04/01/15 04/25/15 Pay Princpl 1,508.906 FNA 2015-M3 FA 1MOFRN CMBS 06/25/18 0.42 3136AMMC 1,508.91 1,508.91 04/01/15 04/25/15 Pay Princpl 852 , 503 . 260 FNA 2015-M4 FA 1MOFRN CMBS 09/25/18 0.38 3136AMTM 852 , 503 . 26 852 , 503 . 26 1,851,271.439 1,851,271.45 1,851,271.45
04/01/15 04/01/15 Mature Long 32,873,000.000 FHLB DISCOUNT NOTE 04/01/15 313384DU0 32,872,287.75 712.25 32,873,000.00
04/01/15 04/01/15 Mature Long 18,500,000.000 FHLMC DISCOUNT NOTE 04/01/15 313396DU4 18,499,599.17 400.83 18,500,000.00
04/02/15 04/02/15 Mature Long 50,000,000.000 FNMA DISCOUNT NOTE 04/02/15 313588DV4 49,996,041.67 3,958.33 50,000,000.00
04/02/15 04/02/15 Mature Long 13,700,000.000 FNMA DISCOUNT NOTE 04/02/15 313588DV4 13,698,915.42 1,084.58 13,700,000.00
04/02/15 04/02/15 Mature Long 50,000,000.000 U.S. TREASURY BILL 04/02/15 912796DU0 49,999,587.50 412.50 50,000,000.00
04/09/15 04/09/15 Mature Long 50,000,000.000 U.S. TREASURY BILL 04/09/15 912796FC8 49,999,878.47 121.53 50,000,000.00
04/09/15 04/09/15 Mature Long 50,000,000.000 U.S. TREASURY BILL 04/09/15 912796FC8 49,999,958.33 41.67 50,000,000.00
04/21/15 04/21/15 Mature Long 50,000,000.000 TVA DISCOUNT NOTE 04/21/15 880592EQ9 49,999,416.67 583.33 50,000,000.00
04/21/15 04/21/15 Mature Long 50,000,000.000 TVA DISCOUNT NOTE 04/21/15 880592EQ9 49,999,416.67 583.33 50,000,000.00
04/21/15 04/21/15 Mature Long 20,000,000.000 TVA DISCOUNT NOTE 04/21/15 880592EQ9 19,999,766.67 233.33 20,000,000.00
04/24/15 04/24/15 Mature Long 25,000,000.000 FHLB DISCOUNT NOTE 04/24/15 313384ET2 24,999,916.67 83.33 25,000,000.00
04/24/15 04/24/15 Mature Long 13,290,000.000 FHLB DISCOUNT NOTE 04/24/15 313384ET2 13,289,961.24 38.76 13,290,000.00 04/24/15 04/24/15 Mature Long 16 ,600 , 000 . 000 FHLB DISCOUNT NOTE 04/24/15 313384ET2 16 ,599 , 944 . 67 55 . 33 16 ,600 , 000 . 00 439,963,000.000 439,954,690.90 8,309.11 439,963,000.00
Payden & Rygel 186 Page 9 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN 04/01/2015 Account Number: through 04/30/2015
Trade Settlement Transaction MaturityCoupon Accrued Interest Total D a te D a te T y pe U nits De scr i p tion D a te R a te C U S IP Pr o cee ds / ( Co s t) ( P u rc h ) o r Sold Amount 04/01/15 04/01/15 Withdrawal (80,000,000.000) WD USD (80,000,000.00) (80,000,000.00)
04/09/15 04/09/15 Withdrawal (225,000,000.000) WD USD (225,000,000.00) (225,000,000.00)
04/13/15 04/13/15 Withdrawal (100,000,000.000) WD USD (100,000,000.00) (100,000,000.00) 04/30/15 04/30/15 Withdrawal (50 ,000 , 000 . 000) WD USD (50 ,000 , 000 . 00) (50 ,000 , 000 . 00) 455,000,000.000) (455,000,000.00) (455,000,000.00)
Payden & Rygel 187Page 10 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN-LOW DURATION PORT 04/01/2015 Account Number: through 04/30/2015
Trade Settlement Transaction MaturityCoupon Accrued Interest Total D a te D a te T y pe U nits De scr i p tion D a te R a te C U S IP Pr o cee ds / ( Co s t) ( P u rc h ) o r Sold Amount 04/10/15 04/14/15 Buy 835,000.000 PRIVATE EXPORT FUNDING CP 01/05/16 7426M2A5 (832,840.60) (832,840.60)
04/10/15 04/16/15 Buy 300,000.000 NEW YORK UNIVERSITY 07/01/17 0.90 650119AD2 (300,000.00) (300,000.00)
04/20/15 04/23/15 Buy 385,033.830 FNA 2015-M4 FA 1MOFRN CMBS 09/25/18 0.38 3136AMTM (385,033.83) (90.47) (385,124.30)
04/22/15 04/29/15 Buy 800,000.000 CHASE 2015-A3 A CDT 04/15/19 0.43 161571GW (800,000.00) (800,000.00) 04/27/15 04/30/15 Buy 300 , 000 . 000 PEPSICO 04/30/18 1.25 713448CR7 (299 , 964 . 00) (299 , 964 . 00) 2,620,033.830 (2,617,838.43) (90.47) (2,617,928.90)
04/01/15 04/01/15 Coupon CA GOLDEN EMPIRE SFA LEASE 05/01/15 0.31 381008AR2 112.11 112.11
04/07/15 04/07/15 Coupon NATL RURAL UTILITIES FRN 05/01/15 0.32 63743HEJ7 356.73 356.73
04/07/15 04/07/15 Coupon ORACLE FRN 07/07/17 0.47 68389XAT2 453.60 453.60
04/10/15 04/10/15 Coupon METLIFE GLOBAL FRN 144A 04/10/17 0.65 59217GBE8 973.43 973.43
04/11/15 04/11/15 Coupon DUKE ENERGY INDIANA FRN 07/11/16 0.63 263901AE0 391.37 391.37
04/11/15 04/11/15 Coupon WAL-MART STORES 04/11/16 0.60 931142DE0 270.00 270.00
04/13/15 04/13/15 Coupon FFCB 1ML FRN 02/13/17 0.22 3133EDFB3 744.00 744.00
04/13/15 04/13/15 Coupon GE CAPITAL CORP FRN 07/12/16 0.93 36962G7A6 1,071.74 1,071.74
04/15/15 04/15/15 Coupon HONDA 2014-4 A2 CAR 01/17/17 0.58 43814JAB0 316.58 316.58
04/15/15 04/15/15 Coupon JOHN DEERE 2014-A A3 EQP 04/16/18 0.92 47787VAC5 1,150.00 1,150.00
04/15/15 04/15/15 Coupon JOHN DEERE 2015-A A2A EQP 02/15/18 0.87 47787UAB9 645.01 645.01
04/15/15 04/15/15 Coupon TOYOTA 2013-B A3 CAR 07/17/17 0.89 89236VAC4 741.67 741.67
04/15/15 04/15/15 Coupon TOYOTA 2013-B A3 CAR 07/17/17 0.89 89236VAC4 155.75 155.75
04/15/15 04/15/15 Coupon TOYOTA 2015-A A2 CAR 07/17/17 1.01 89236WAB 529.13 529.13
Payden & Rygel 188 Page 1 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN-LOW DURATION PORT 04/01/2015 Account Number: through 04/30/2015
Trade Settlement Transaction MaturityCoupon Accrued Interest Total D a te D a te T y pe U nits De scr i p tion D a te R a te C U S IP Pr o cee ds / ( Co s t) ( P u rc h ) o r Sold Amount 04/15/15 04/15/15 Coupon U.S. TREASURY NOTE 04/15/16 0.25 912828UW 10,200.00 10,200.00
04/15/15 04/15/15 Coupon U.S. TREASURY NOTE 04/15/16 0.25 912828UW 10,450.00 10,450.00
04/15/15 04/15/15 Coupon USAA 2014-1 A2 CAR 10/17/16 0.38 90290KAB1 45.46 45.46
04/15/15 04/15/15 Coupon USAA 2014-1 A3 CAR 12/15/17 0.58 90290KAC9 273.08 273.08
04/17/15 04/17/15 Coupon JOHN DEERE CAPITAL 04/17/15 0.88 24422ERQ4 1,793.75 1,793.75
04/17/15 04/17/15 Coupon FFCB 1ML FRN 04/17/17 0.23 3133EDJX1 292.56 292.56
04/18/15 04/18/15 Coupon HONDA 2013-4 A3 CAR 09/18/17 0.69 43814FAC6 575.00 575.00
04/20/15 04/20/15 Coupon WELLS FARGO FRN 07/20/15 0.56 94985H5G5 1,073.20 1,073.20
04/22/15 04/22/15 Coupon GEEMT 2014-1 A2 EQP 04/24/17 0.64 36163TAB9 266.67 266.67
04/23/15 04/23/15 Coupon BNY MELLON 10/23/15 0.70 06406HCD 2,625.00 2,625.00
04/23/15 04/23/15 Coupon GEET 2015-1 A2 EQP 11/24/17 0.89 36164EAB1 254.39 254.39
04/23/15 04/23/15 Coupon NEW YORK LIFE GLOBAL FRN 14 05/23/16 0.63 64952WBP 607.10 607.10
04/25/15 04/25/15 Coupon BMW 2013-A A3 CAR 11/27/17 0.67 05578XAC2 483.73 483.73
04/01/15 04/25/15 Coupon FHMS K501 A1 CMBS 06/25/16 1.34 3137ANLN3 43.42 43.42
04/01/15 04/25/15 Coupon FHMS K502 A1 CMBS 12/25/16 0.73 3137B03V4 239.74 239.74
04/25/15 04/25/15 Coupon FHMS KF01 A 1MOFRN CMBS 04/25/19 0.52 3137AUP52 52.95 52.95
04/01/15 04/25/15 Coupon FNA 2014-M2 ASQ2 CMBS 09/25/15 0.48 3136AJDN3 100.48 100.48
04/01/15 04/25/15 Coupon FNA 2014-M2 ASQ2 CMBS 09/25/15 0.48 3136AJDN3 39.95 39.95
04/01/15 04/25/15 Coupon FNA 2014-M4 ASQ2 CMBS 01/25/17 1.27 3136AJB21 715.66 715.66
04/01/15 04/25/15 Coupon FNA 2014-M5 FA 1MOFRN CMBS 01/25/17 0.56 3136AJ2A3 120.58 120.58
Payden & Rygel 189 Page 2 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN-LOW DURATION PORT 04/01/2015 Account Number: through 04/30/2015
Trade Settlement Transaction MaturityCoupon Accrued Interest Total D a te D a te T y pe U nits De scr i p tion D a te R a te C U S IP Pr o cee ds / ( Co s t) ( P u rc h ) o r Sold Amount 04/01/15 04/25/15 Coupon FNA 2014-M5 FA 1MOFRN CMBS 01/25/17 0.56 3136AJ2A3 120.58 120.58
04/01/15 04/25/15 Coupon FNA 2014-M8 FA 1MOFRN CMBS 05/25/18 0.44 3136AKQJ5 308.67 308.67
04/01/15 04/25/15 Coupon FNA 2015-M4 FA 1MOFRN CMBS 09/25/18 0.38 3136AMTM 378.09 378.09
04/27/15 04/27/15 Coupon JPMORGAN CHASE FRN 01/25/18 1.18 46625HJF8 613.70 613.70
04/29/15 04/29/15 Coupon FFCB 1ML FRN 08/29/17 0.22 3133EDTT9 300.01 300.01 04/30/15 04/30/15 Coupon US BANK CINCINNATI FRN 01/30/17 0.51 90331HMD 484 . 60 484 . 60 40,369.49 40,369.49
04/01/15 04/01/15 Income 10.250 STIF INT USD 10.25 10.25
04/13/15 04/14/15 Sell Long 1,000,000.000 U.S. TREASURY NOTE 02/29/16 0.25 912828B82 1,000,231.03 305.71 1,000,536.74 04/29/15 04/30/15 Sell Long 500 , 000 . 000 U.S. TREASURY NOTE 02/29/16 0.25 912828B82 500 , 193 . 64 207 . 20 500 , 400 . 84 1,500,000.000 1,500,424.67 512.91 1,500,937.58
04/15/15 04/15/15 Pay Princpl 51,007.648 TOYOTA 2013-B A3 CAR 07/17/17 0.89 89236VAC4 51,007.65 51,007.65
04/15/15 04/15/15 Pay Princpl 10,711.606 TOYOTA 2013-B A3 CAR 07/17/17 0.89 89236VAC4 10,711.61 10,711.61
04/15/15 04/15/15 Pay Princpl 33,412.561 USAA 2014-1 A2 CAR 10/17/16 0.38 90290KAB1 33,412.56 33,412.56
04/25/15 04/25/15 Pay Princpl 66,067.111 BMW 2013-A A3 CAR 11/27/17 0.67 05578XAC2 66,067.11 66,067.11
04/01/15 04/25/15 Pay Princpl 16,807.980 FHMS K501 A1 CMBS 06/25/16 1.34 3137ANLN3 16,807.98 16,807.98
04/01/15 04/25/15 Pay Princpl 5,842.320 FHMS K502 A1 CMBS 12/25/16 0.73 3137B03V4 5,842.32 5,842.32
04/25/15 04/25/15 Pay Princpl 312.960 FHMS KF01 A 1MOFRN CMBS 04/25/19 0.52 3137AUP52 312.96 312.96
04/01/15 04/25/15 Pay Princpl 19,558.170 FNA 2014-M2 ASQ2 CMBS 09/25/15 0.48 3136AJDN3 19,558.17 19,558.17
Payden & Rygel 190 Page 3 TRANSACTIONS BY TYPE
Account Name: L.A. CARE HEALTH PLAN-LOW DURATION PORT 04/01/2015 Account Number: through 04/30/2015
Trade Settlement Transaction MaturityCoupon Accrued Interest Total D a te D a te T y pe U nits De scr i p tion D a te R a te C U S IP Pr o cee ds / ( Co s t) ( P u rc h ) o r Sold Amount 04/01/15 04/25/15 Pay Princpl 7,776.140 FNA 2014-M2 ASQ2 CMBS 09/25/15 0.48 3136AJDN3 7,776.14 7,776.14
04/01/15 04/25/15 Pay Princpl 13,438.740 FNA 2014-M5 FA 1MOFRN CMBS 01/25/17 0.56 3136AJ2A3 13,438.74 13,438.74
04/01/15 04/25/15 Pay Princpl 13,438.740 FNA 2014-M5 FA 1MOFRN CMBS 01/25/17 0.56 3136AJ2A3 13,438.74 13,438.74
04/01/15 04/25/15 Pay Princpl 16,496.433 FNA 2014-M8 FA 1MOFRN CMBS 05/25/18 0.44 3136AKQJ5 16,496.43 16,496.43 04/01/15 04/25/15 Pay Princpl 71 , 853 . 850 FNA 2015-M4 FA 1MOFRN CMBS 09/25/18 0.38 3136AMTM 71 , 853 . 85 71 , 853 . 85 326,724.259 326,724.26 326,724.26
04/17/15 04/17/15 Mature Long 410,000.000 JOHN DEERE CAPITAL 04/17/15 0.88 24422ERQ4 410,000.00 410,000.00
Payden & Rygel 191 Page 4 BOARD OF GOVERNORS Finance & Budget Committee Meeting Minutes April 30, 2015 1055 W. 7th Street, Los Angeles, CA 90017 Members Management/Staff Guest/Public John Baackes, Chief Executive officer Alan Bloom, Care1st Michael Rembis, Chairperson Gertrude S. Carter, MD, Chief Medical Officer Laurie Garcia, Anthem Blue Cross Jann Hamilton Lee Jonathan Freedman, Chief of Strategy, Regulatory & External Affairs Avanti Wadu, iHealth, Inc. Thomas Horowitz, DO Augustavia Haydel, General Counsel Ozzie Lopez Tim Reilly, Chief Financial Officer Louise McCarthy, Secretary *Absent ** Via Teleconference
AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN CALL TO ORDER Michael Rembis, Chairperson, called the meeting to order at 1:15 p.m. Michael Rembis Chairperson Rembis announced that members of the public may address the Committee on each matter listed on the agenda before or during the Committee’s consideration of the item, or on any other topic at the Public Comment section.
APPROVE MEETING Chairperson Rembis proposed adding the following motions on today’s consent Approved unanimously as AGENDA Agenda: FIN-A Laura Gonzalez Contract Amendment, FIN 104 Procurement of amended. 4 AYES Additional Managed Service Hours from Black Box Network, FIN 108 Inovalon, and (Hamilton Lee, Horowitz, Michael Rembis FIN 109 Gomez Research Contract. He also noted a typographical error on the Laura McCarthy, and Rembis) Gonzalez motion, the correct term date of the contract should be March 2, 2015 through February 29, 2016. The Agenda for today’s meeting was approved as amended.
PUBLIC COMMENTS There were no public comments.
APPROVE MEETING The minutes from March 24, 2015 were approved as presented. Approved unanimously. MINUTES 4 AYES.
APPROVED 192 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN ADJOURN TO CLOSED Augustavia J. Haydel, Esq., General Counsel, announced that the Committee will discuss the following items in closed SESSION session. There was no public comment on the Closed Session items and the meeting adjourned to closed session at 1:17 p.m. A. CONTRACT RATES Pursuant to Welfare and Institutions Code Sect. 14087.38 (m) Provider Rates Plan Partner Medi-Cal Rates DHCS Medi-Cal Rates (Member Lopez joined the meeting.) B. REPORT INVOLVING TRADE SECRETS Pursuant to Welfare & Institutions Code 14087.38 (n) Discussion concerning New Product Lines Estimated date of disclosure April 2017
RECONVENE IN OPEN The meeting reconvened in open session at 1:37 p.m. No reportable actions were SESSION taken during the closed session. Michael Rembis
CHAIRPERSON’S There was no report from the Chairperson. REPORT CHIEF EXECUTIVE John Baackes, Chief Executive Officer, reported: OFFICER REPORT John Wallace resigned earlier this month from his role as L.A. Care’s Chief Operating Officer (COO). His last day was today. For the past nine years Mr. Wallace provided operational leadership during a time of growth for the organization. In his role he oversaw the roll out of several health care reform programs including the launch of L.A. Care Covered, transition of seniors and people with disabilities (SPDs), and dual eligible into Managed Care, as well as the expansion of Medi-Cal. Mr. Baackes noted that Mr. Wallace provided excellent leadership as Interim CEO, and was very gracious with his time in helping orient Mr. Baackes to L.A. Care operations and culture. Jonathan Freedman, Chief of Strategy, Regulatory and External Affairs, has been
Finance and Budget Committee April 30, 2015 APPROVED 193 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN appointed as interim COO, and Bruce Pollack, Sr. Director of Project Management Office, has been appointed as Core System Conversion “Czar”. As discussed at prior meetings, L.A. Care was audited by the L.A. County Auditor- Controller in January 2015. L.A. Care agreed with the recommendations made by the Auditor-Controller, and will present revised expense policies for Committee’s review and approval later on today’s Agenda. The Auditor’s final report will be presented to the L.A. County Board of Supervisors on May 29, 2015. On May 13, 2015, I have a meeting with the Auditor Controller to better understand the scope of future audits. APPROVE COMMITTEE Chairperson Rembis presented a Consent Agenda for Committee review and CONSENT AGENDA consideration: 1. Quarterly Investment Report Motion FIN 100 To accept the Investment Report for the quarter ended March 31, 2015, as submitted. 2. Laura Gonzalez Contract Amendment Motion FIN-A To authorize staff to amend a contract with Laura D. Gonzalez in the Approved unanimously amount of $12,000 (total amount not to exceed $113,100) to provide Nutrition 5 AYES (Hamilton Lee, Workshops for the Active Steps Program from March 2, 2015 through Horowitz, Lopez, February 29, 2016. McCarthy, and Rembis) 3. Procurement of Additional Managed Service Hours from Black Box Network Services Motion FIN 104 To authorize staff to procure additional Managed Service Hours with Black Box Network Services to support L.A. Care’s Interactive Voice Response (IVR) and Voicemail System upgrade in an amount of $40,000 (total contract not to exceed $504,000) through May 31, 2016. 4. Inovalon Contract Amendment Motion FIN 108 To approve an amendment with Inovalon, Inc. to increase funds in the
Finance and Budget Committee April 30, 2015 APPROVED 194 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN amount of $90,000; bringing the total three year contract cost from $1,183,920 to $1,273,920 for the period of August 1, 2014 to August 31, 2017. 5. Gomez Research Contract Motion FIN 109 To authorize staff to execute a contract in the amount of $250,000 with Gomez Research to provide market research services from June 1, 2015 to June 1, 2017.
COMMITTEE ISSUES CHIEF FINANCIAL Tim Reilly, Chief Financial Officer, reviewed highlights of the financial report for the OFFICER REPORT period ending March 2015: Total overall enrollment for March is 1,689,099 members. APPROVE FINANCIAL Fiscal year-to-date performance is a surplus of $64.3 million or 2% on revenue. REPORT Total enrollment for the Plan Partner (PP) Network is 800,000 members. Fiscal year-to-date performance for PP Network is a surplus of $27million. Total enrollment for L.A. Care’s direct Medi-Cal line of business (MCLA) is 775,000. MCLA’s fiscal year-to-date performance is a surplus of $64 million, mainly driven by higher than expected Medi-Cal Expansion membership growth and lower than budgeted operating expenses. Total enrollment for the Cal MediConnect (CMC) program is over 15,000. Fiscal year-to-date performance is a deficit of $16 million driven by lower than budgeted revenue rates and higher than budgeted operating expenses. Chairperson Rembis noted concerns in regard to the deficit in the CMC program and requested staff to report back to the Committee on projections for breakeven. Motion FIN 101 Approved unanimously. To accept the Financial Report for the six months ended March 31, 2015, as 5 AYES submitted. RESPONSE TO L.A. Mr. Reilly presented a motion to approve the revisions to the Expense and Travel COUNTY AUDITOR Expense policies. The revisions include: Defining expenses that are non-travel related versus travel related and that are necessary, reasonable, appropriate, and allowable. Finance and Budget Committee April 30, 2015 APPROVED 195 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN Procedures on pre-approving all non-travel related business expenses. Procedures for using the most recent federal guidelines for meal dollar limits per person. Setting a $5,000 per project expense limit that requires approvals from the responsible Officer, Chief Financial Officer, Chief Executive Officer, and or Board of Governors. Procedures for monitoring and reporting which include quarterly reports to the Board of Governors. Eliminating purchase of alcoholic beverages; meals or entertainment expenses with vendors or firms seeking to do business with L.A. Care; routine working lunches; and meals or entertainment for birthdays, retirement, or similar related activities. Updated procedures on pre-approving all L.A. Care business related travel expenses via travel authorization requests. Updated procedures on preparing expense reports and documentation requirements for reimbursement for L.A. Care business travel. Updated guidelines on travel expenses that are covered and not covered under this policy. Prohibits the purchase or reimbursement of alcoholic beverages with L.A. Care funds. In response to a question from Chairperson Rembis, Mr. Reilly informed the Committee that the changes to the policies do not intend to eliminate appropriate events but to set specific limits. In response to comments from Members Hamilton Lee and McCarthy, Jonathan Freedman, Interim Chief Operating Officer, Chief of Strategy, Regulatory and External Affairs, noted that the suggested changes include a broad range of activities for employee recognition and retention. In addition, Mr. Reilly informed the Committee that the changes include a number of categories including Board and Committee meetings and marketing, and set a maximum per person cost as well as annual expense guidelines. Motion FIN 102 To approve the Expense and Travel Expense Policies, as attached, and to authorize staff to make non-significant changes.
Finance and Budget Committee April 30, 2015 APPROVED 196 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN Chairperson Rembis requested the motion be amended as follows: Amended Motion FIN 102 Approved unanimously as 1) To approve the Expense and Travel Expense Policies, as attached, and to amended. 5 AYES authorize staff to make non-significant changes; and; 2) To direct staff to report on the policies to the Finance and Budget Committee and the Board in 6 months from their adoption and for the Committee and the Board to reevaluate the policies in one year from their adoption. MONTHLY Mr. Reilly informed the Committee that as of March 31, 2015, L.A. Care’s total INVESTMENT REPORT investments market value was $1,717 million. This includes $50 million invested with the Los Angeles County Pooled Investment Fund (LACPIF) and $10, million with the Local Agency Investment Fund (LAIF). Both of these are recent placements with these government pooled funds which are overseen by the County Treasurer (LACPIF) and State Treasurer’s office (LAIF) respectively. The remainder $1,658 million is managed by Payden & Rygel, an external professional asset management firm, and is divided into two separate portfolios based on investment style, short-term and extended portfolios in compliance with applicable state law. Mr. Reilly noted that this is an informational report, and Committee action is not required. APPROVE OPERATIONS MOTIONS LAURA GONZALEZ Jonathan Freedman, Interim Chief Operating Officer and Chief of Strategy, Regulatory and CONTRACT External Affairs, presented the following motions: AMENDMENT This motion was approved earlier under consent Agenda. Motion FIN-A* To authorize staff to amend a contract with Laura D. Gonzalez in the amount of Approved unanimously $12,000 (total amount not to exceed $113,100) to provide Nutrition Workshops under Consent Agenda for the Active Steps Program from March 2, 2015 through February 29, 2016. 5 AYES
NORTH STAR Mr. Freedman noted a typographical error on this motion, and informed the ALLIANCE Committee that the total amount requested is $ 275,000. Regina Lightner, Senior Director, Sales and Marketing, presented a motion to approve a Finance and Budget Committee April 30, 2015 APPROVED 197 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN contract with North Star Alliance to provide a series of community outreach events in Los Angeles County to promote all of L.A. Care’s direct lines of business. Ms. Lightner noted that this contract offers an opportunity for the vendor to identify community events and activities to better utilize field staff, navigators, and certified enrollment counselors. Motion FIN-B To authorize staff to execute a contract with North Star Alliance, in the amount of $275,000 to provide a series of community outreach events in Los Angeles, County to promote all of L.A. Care’s direct lines of business for the period of June 1, 2015 through May 31, 2016. MARICICH Ms. Lightner presented a motion to amend a contract with Maricich Healthcare HEALTHCARE Communications (Maricich) to support advertising, marketing, translation services and COMMUNICATIONS development of an integrated brand strategy and positioning for L.A. Care’s direct lines Motions FIN-B, FIN 103 CONTRACT of business. and FIN-C were AMENDMENT simultaneously approved In response to questions from Chairperson Rembis, Mr. Freedman informed the unanimously. 5 AYES Committee that L.A. Care receives additional credit, news, monitoring and tailored deployment as part of this contract. He noted that L.A. Care can measure the effectiveness of Maricich’s efforts through videos, images and by monitoring click through. In response to question from Member López, Ms. Lightner informed the Committee, that L.A. Care continues trying to identify areas for public education, such as initiatives, partnerships, information and materials. Mr. Baackes noted the importance of helping By consensus, the potential members and provider understand L.A. Care’s brand, as opposed to just Committee recommended recognizing the logo. motion FIN 103 be included in the Consent Motion FIN 103 Agenda for the May 7, To authorize staff to amend a contract with Maricich Healthcare 2015 Board meeting Communications in the amount of $4,710,000 (total contract amount not to exceed $9,310,000) to support the advertising, marketing, translation services, and development of an integrated brand strategy and positioning for L.A. Care’s direct lines of business from September 1, 2015 through August 31, 2016.
Finance and Budget Committee April 30, 2015 APPROVED 198 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN TELEMUNDO 52 Ms. Lightner also presented a motion to contract with Telemundo 52 to provide CONTRACT advertising and marketing services. She informed the Committee that L.A. Care has worked with Telemundo on targeted campaigns at the L.A. Care Family Resource Centers and noted that this contract aligns with the one for North Star Alliance. She further noted that Telemundo primarily focuses on the Spanish speaking communities and is able to tell L.A. Care’s story through vignettes. Telemundo has broadcasted staff talking about L.A. Care Covered, and has provided additional support and services. Motion FIN-C To authorize staff to execute a contract with Telemundo 52, in the amount of $250,000 to provide advertising and marketing services from June 1, 2015 through June 1, 2016. APPROVE Tom Schwaninger, Chief Information Officer, presented the following motions: INFORMATION TECHNOLOGY MOTIONS PROCUREMENT OF This motion was approved earlier under consent Agenda. ADDITIONAL Motion FIN 104 MANAGED SERVICE Approved earlier under To authorize staff to procure additional Managed Service Hours with Black Box HOURS FROM BLACK Consent Agenda. Network Services to support L.A. Care’s Interactive Voice Response (IVR) and BOX NETWORK 5 AYES Voicemail System upgrade in an amount of $40,000 (total contract not to exceed SERVICES $504,000) through May 31, 2016. KEY VENDOR Contract with e Plus in the amount of $650,000 to procure equipment and installation CONTRACT TO services for the purpose of expanding disk storage infrastructure. L.A. Care conducted ENHANCE DISK a request for quotes process from four vendors. Between the time this motion was STORAGE SPACE assembled and today’s meeting, e Plus was selected as the vendor of choice because they provided the lowest bid. FIN 105, and FIN 106 were approved Motion FIN 105* unanimously. To authorize staff to execute a contract with a vendor not yet selected to procure 5 AYES equipment and installation services for the purpose of expanding disk storage infrastructure in the amount of $650,000. By consensus, the
Finance and Budget Committee April 30, 2015 APPROVED 199 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN HEALTHX CONTRACT Healthx was selected as the vendor of choice for L.A. Care’s Member and Provider Committee recommended Portal Strategic implementation services following a competitive request for proposal these motions be process. This motion requests authorization to extend the term of the contract with included in the Consent Healthx through March 31, 2017 and requests an additional $2,500,000 to establish and Agenda for the May 7, update a more robust and secure technical infrastructure of the Member and Provider 2015 Board meeting. portal to meet National Committee for Quality Assurance (NCQA) standards and Health Insurance Portability and Accountability (HIPAA) requirements. Motion FIN 106* To execute a contract with Healthx for L.A. Care’s Member and Provider Portal Strategic implementation services, for an amount of $2,500,000, through March 31, 2017. INNOVALON This motion was approved earlier under consent Agenda. CONTRACT Motion FIN 108* AMENDMENT Approved unanimously To approve an amendment with Inovalon, Inc. to increase funds in the amount under Consent Agenda. of $90,000; bringing the total three year contract cost from $1,183,920 to 5 AYES $1,273,920 for the period of August 1, 2014 to August 31, 2017.
GOMEZ RESEARCH This motion was approved earlier under consent Agenda. CONTRACT Approved unanimously Motion FIN 109* under Consent Agenda. To authorize staff to execute a contract in the amount of $250,000 with Gomez 5 AYES Research to provide market research services from June 1, 2015 to June 1, 2017. SECOND QUARTER Mr. Freedman reported: FISCAL YEAR 2014-15 In September 2014, the Board reauthorized the second year of the prequalified vendor PREQUALIFIED program. In the second quarter of fiscal year 2014-15, two vendors were used for two VENDOR REPORT new projects, and three projects activated in fiscal year 2013-14 were amended or extended with the respective vendors. One vendor has reached the 50% threshold during the second quarter for available funds in this fiscal year. Member Lopez asked for a report on the Executive Community Advisory Committee (ECAC) budget, and requested an item be placed on the next meeting Agenda to discuss ways for the Advisory Committee to maximize the budget allotted during each
Finance and Budget Committee April 30, 2015 APPROVED 200 AGENDA ITEM/PRESENTER MOTIONS / MAJOR DISCUSSIONS ACTION TAKEN fiscal year. In addition, Chairperson Rembis requested an accounts payable report on high volume providers. ADJOURNMENT The meeting adjourned at 2:20 p.m. APPROVED BY: Respectfully submitted by: Hilda Stuart, Committee Liaison, Board Services ______Linda Merkens, Manager, Board Services Michael Rembis, Chair Date Signed ______
Finance and Budget Committee April 30, 2015 APPROVED 201 202 203 204 205 206 207 208 209 210 211 Schedule of Meetings June 2015
Monday Tuesday Wednesday Thursday Friday Saturday Sunday 1 2 3 4 5 6 7 Board of Governors 2 pm (for approximately 2 hours)
8 9 10 11 12 13 14 ECAC 10 am (for approximately 2 hours) 15 16 17 18 19 20 21 Governance 3 pm (for approximately 2 hours)
22 23 24 24 26 27 28 Finance & Budget 1 pm (for approximately 1-1/2 hours) Executive 2:30 pm (for approximately 2 hours) 29 30
For information on the current month’s meetings, check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. 212 Prepared by mhbalones/printed on 05/29/15 Board of Governors & Public Advisory Committees 2015 Meeting Schedule / Member Listing 1055 W. 7th Street, 10th Floor, Los Angeles, CA 90017 Tel. (213) 694-1250 / Fax (213) 438-5728
MEETINGDAY,TIME, MEETINGDATES &LOCATION MEMBERS Board of 1st Thursday June 4 Thomas Horowitz, DO, Chairperson Governors 2:00 PM July 30* Mark Gamble, Vice Chairperson General Meeting (for approximately 3 hours) No meeting in August Michael Rembis, FACHE, Treasurer 1055 W. 7th Street, September 3** Louise McCarthy, Secretary 10th Floor, October 1*** Honorable Michael D. Antonovich Los Angeles, CA 90017 November 5 Hector De La Torre December 3*** Jann Hamilton Lee Alexander K. Li, MD *Rescheduled from Ozzie Lopez July 2 due to holidays Hilda Perez G. Michael Roybal, MD, MPH ** All Day Board Sheryl Spiller Retreat – location to Kimberly Uyeda, MD, MPH be determined
***Strategic Focus Staff Contact: from 12:00-2:00 p.m. in John Baackes, Chief Executive Officer addition to regular x4102 Board meeting from Samantha Leewood, Interim Manager, 2:00-5:00 p.m. Board Services, x4938
For information on the current month’s meetings, check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. 213 BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2015 MEETINGSCHEDULE / MEMBER LISTING
Board of Governors - Standing Committees
MEETINGDAY, 2015 TIME, MEETING MEMBERS &LOCATION DATES Executive 4th Wednesday of the June 24 Thomas Horowitz, DO, Chairperson Committee month July 22 Mark Gamble 2:30 PM No meeting in Michael Rembis (for approximately 2 hours) August Louise McCarthy 1055 W. 7th Street, September 23 G. Michael Roybal, MD, MPH 10th Floor, Los Angeles, October 28 Alexander K Li, MD CA 90017 November 18** No meeting in *moved due scheduling December Staff Contact: conflicts Samantha Leewood, Interim Manager, ** moved due to Board Services, x4938 Thanksgiving holiday Compliance & 3rd Thursday every 2 July 16 G. Michael Roybal, MD, MPH, Quality months No meeting in Chairperson Committee 2:30 PM August Jann Hamilton Lee (for approximately 2 hours) September 17 Alexander Li, MD November 19 Hilda Perez 1055 W. 7th Street, No meeting in 10th Floor, Los Angeles, December Staff Contact: CA 90017 Malou Balones Committee Liaison, Board Services, x 4183
Finance & 4th Wednesday of the June 24 Michael A. Rembis, FACHE, Chairperson Budget month July 22 Jann Hamilton Lee Committee 1:00 PM No meeting in Thomas Horowitz, DO (for approximately 2 hours) August Ozzie Lopez September 23 Louise McCarthy 1055 W. 7th Street, October 28 10th Floor, Los Angeles, November 18** CA 90017 No meeting in Staff Contact: December Hilda Stuart *moved due scheduling Committee Liaison, Board Services, x 4184 conflicts ** moved due to Thanksgiving holiday
For information on the current month’s meetings, check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. 214 BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2015 MEETINGSCHEDULE / MEMBER LISTING
MEETINGDAY, 2015 TIME, MEETING MEMBERS &LOCATION DATES Governance 1055 W. 7th Street, Thursday Alexander K Li, MD, Chairperson Committee 10th Floor June 18 Hector De La Torre Los Angeles, CA 90017 3 – 5 pm Mark Gamble Ozzie Lopez MEETS AS NEEDED Hilda Perez Sheryl Spiller
Staff Contact: Malou Balones Committee Liaison, Board Services/x 4183
Service 1055 W. 7th Street, Hector De La Torre, Chairperson Agreement 10th Floor Louise McCarthy Committee Los Angeles, CA 90017 Hilda Perez Sheryl Spiller MEETS AS NEEDED Staff Contact Malou Balones Committee Liaison, Board Services/x 4183
Audit Committee 1055 W. 7th Street, G. Michael Roybal, MD, MPH, 10th Floor Chairperson Los Angeles, CA 90017 Jann Hamilton Lee Alexander K. Li, MD MEETS AS NEEDED Staff Contact Malou Balones Committee Liaison, Board Services, x 4183
For information on the current month’s meetings, check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. 215 BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2015 MEETINGSCHEDULE / MEMBER LISTING
MEETINGDAY, MEETING TIME, DATES MEMBERS &LOCATION L.A. Care Meets Annually or as Thomas Horowitz, DO, Chairperson Community needed Mark Gamble, Vice Chairperson Health 1055 W. 7th Street, Michael Rembis, FACHE, Treasurer 10th Floor, Los Angeles, Louise McCarthy, Secretary CA 90017 Honorable Michael D. Antonovich Hector De La Torre Jann Hamilton Lee Alexander K. Li, MD Ozzie Lopez Hilda Perez G. Michael Roybal, MD, MPH Sheryl Spiller Kimberly Uyeda, MD, MPH
Staff Contact: John Baackes, Chief Executive Officer x4102 Samantha Leewood, Interim Manager, Board Services, x4938
L.A. Care Joint Meets Quarterly or as Thomas Horowitz, DO, Chairperson Powers Authority needed Mark Gamble, Vice Chairperson 1055 W. 7th Street, Michael Rembis, FACHE, Treasurer 10th Floor, Los Angeles, Louise McCarthy, Secretary CA 90017 Honorable Michael D. Antonovich Hector De La Torre Jann Hamilton Lee Alexander K. Li, MD Ozzie Lopez Hilda Perez G. Michael Roybal, MD, MPH Sheryl Spiller Kimberly Uyeda, MD, MPH
Staff Contact: John Baackes, Chief Executive Officer x4102 Samantha Leewood, Interim Manager, Board Services, x4938
For information on the current month’s meetings, check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. 216 BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2015 MEETINGSCHEDULE / MEMBER LISTING
Public Advisory Committees MEETINGDAY, MEETING TIME, DATES STAFFCONTACT &LOCATION Children’s Health 3rd Tuesday of every other July 21 Lyndee Knox, PhD, Chairperson Consultant Advisory month September 15 Committee 8:30 AM November 17 General Meeting (for approximately 2 hours) Staff Contact: Hilda Stuart 1055 W. 7th Street, Committee Liaison, Board Services, x 4184 10th Floor, Los Angeles, CA 90017
Executive 2nd Wednesday of the June 10 Elda Sevilla, Chairperson Community month July 8 Advisory Committee 10:00 AM No meeting in August (for approximately 2 hours) September 9 October 14 Staff Contact: 1055 W. 7th Street, November 11 Idalia Chitica, Community Outreach & 10th Floor, Los Angeles, December 9 Education, Ext. 4420 CA 90017
Technical Advisory 4th Thursdays every other July 23 Chairperson to be elected Committee month September 24 9:00 AM November 19 (for approximately 2 hours) Staff Contact: Malou Balones 1055 W. 7th Street, Committee Liaison, Board Services/x 4183 10th Floor, Los Angeles, CA 90017
For information on the current month’s meetings, check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. 217 BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2015 MEETINGSCHEDULE / MEMBER LISTING
REGIONALCOMMUNITYADVISORYCOMMITTEES
MEETINGDAY, REGION TIME, MEETING STAFFCONTACT &LOCATION DATE Region 1 3rd Friday of every other June 19 Adela Guadarrama, Chairperson Antelope Valley month August 21 10:00 AM October 16 (for approximately 2-1/2 hours) December 18 Chimbole Cultural Center Staff Contact: 38350 N. Sierra Highway Judy Hsieh Bigman Palmdale, CA 93550 Community Outreach & Education, Ext. (661) 267-5656 4199
Region 2 3rd Monday of every other June 15 Carlos Aguirre, Chairperson San Fernando month August 17 Valley 10:00 AM October 19 (for approximately 2-1/2 hours) December 21 Family Resource Center- Pacoima Staff Contact: 10807 San Fernando Road Judy Hsieh Bigman Pacoima, CA 91331 Community Outreach & Education, Ext. (844) 858-9942 4199
Region 3 3rd Tuesday of every other June 16 Lidia Parra, Chairperson Alhambra, month August 18 Pasadena and 9:30 AM October 20 Foothill (for approximately 2-1/2 hours) December 15 Lake Avenue Community Staff Contact: Foundation Kristina Chung 500 E. Villa Street Community Outreach & Education, Ext. Pasadena, CA 91101 5139 (626) 817-4594
Region 4 3rd Tuesday of every other July 21 Hercilia Salvatierra, Chairperson Hollywood- month September 15 Wilshire, Central 9:00 AM November 17 and Glendale (for approximately 2-1/2 hours) Hollywood High School Parent Center 1521 Highland Avenue Staff Contact: Los Angeles, CA 90028 Kristina Chung (323) 993-1771 Community Outreach & Education, Ext. 5139
For information on the current month’s meetings, check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. 218 BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2015 MEETINGSCHEDULE / MEMBER LISTING
MEETINGDAY, REGION TIME, MEETING STAFFCONTACT &LOCATION DATE Region 5 3rd Monday of every other June 15 Romalda Meza, Chairperson West month August 17 2:00 PM October 19 (for approximately 2-1/2 hours) December 21 Veterans Memorial Building Garden Room Staff Contact: 4117 Overland Avenue Martin Vicente Culver City, CA 90230 Community Outreach & Education, x 4423 (310) 253-6625
Region 6 3rd Thursday of every June 18 Dove Savage Pickney, Chairperson South, Compton, other month August 20 Inglewood 3:00 PM October 15 (for approximately 2-1/2 hours) December 17 Saint John’s Well Child & Family Center 808 W. 58th Street Staff Contact: Los Angeles, CA 90037 Frank Meza (323) 541-1600 Community Outreach & Education, x 4239
Region 7 3rd Thursday of every July 16 Dalia Cadena, Chairperson San Antonio and other month September 17 Bellflower 4:30 PM November 19 (for approximately 2-1/2 hours) Old Timers Foundation Family Center Staff Contact: 3355 E. Gage Avenue Frank Meza Huntington Park, CA 90255 Community Outreach & Education, x 4239 (323) 582-6090
Region 8 3rd Friday of every other July 17 Ana Romo – Chairperson Torrance and month September 18 Harbor 10:30 AM November 20 (for approximately 2-1/2 hours) John Mendez Community Center Staff Contact: 707 W. C Street Frank Meza Wilmington, CA 90748 Community Outreach & Education, x 4239 (310) 549-0052
For information on the current month’s meetings, check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. 219 BOARD OF GOVERNORS & PUBLIC ADVISORY COMMITTEES 2015 MEETINGSCHEDULE / MEMBER LISTING
MEETINGDAY, REGION TIME, MEETING STAFFCONTACT &LOCATION DATE Region 9 3rd Monday of every other July 20 Christina Deh-Lee, Chairperson Long Beach month September 21 9:00 AM November 16 (for approximately 2-1/2 hours) Staff Contact: Miller Family Health Kristina Chung Education Center Community Outreach & Education, Ext. 3820 Cherry Avenue 5139 Long Beach, CA 90807 (562) 570-7987
Region 10 3rd Thursday of every June 18 Aida Aguilar, Chairperson East Los Angeles, other month August 20 Whittier and North- 4:00 PM October 15 East (for approximately 2-1/2 hours) December 17 Staff Contact: Boyle Heights Technology Martin Vicente, Community Outreach & Youth Center Education, Ext. 4423 1600 East 4th Street Los Angeles, CA 90033 Tel. (323) 526-0145
Region 11 3rd Wednesday of every July 16 Elda Sevilla, Chairperson Pomona and El other Month September 17 Monte 9:00 AM November 19 Staff Contact: (for approximately 2-1/2 hours) Martin Vicente, Community Outreach & dA Center for the Arts Education, Ext. 4423 252 D South Main Street Pomona, CA 91766 (909) 397-9716
For information on the current month’s meetings, check calendar of events at www.lacare.org. Meetings may be cancelled or rescheduled at the last moment. To check on a particular meeting, please call (213) 694-1250 or send email to [email protected]. 220